Maya Molcho1, Benaya Rozen-Zvi1,2, Tali Shteinmats1,2, Naomi Ben Dor1,2, Itay Vahav1, Eviatar Nesher1,3, Ruth Rahamimov4,5,6. 1. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 2. Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson campus. 39, Jabutinsky St., Petah-Tikva, Israel. 3. Department of Transplantation, Rabin Medical Center, Beilinson campus, Petah-Tikva, Israel. 4. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. rutir@clalit.org.il. 5. Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson campus. 39, Jabutinsky St., Petah-Tikva, Israel. rutir@clalit.org.il. 6. Department of Transplantation, Rabin Medical Center, Beilinson campus, Petah-Tikva, Israel. rutir@clalit.org.il.
Abstract
BACKGROUND: Proteinuria is common in kidney transplant recipients and has been established as a risk factor for graft-loss and mortality. In the general population, proteinuria has also been tied to a higher risk of cardiovascular disease. There is limited data exploring the association between changes in proteinuria over time and cardiovascular disease in kidney transplant recipients. METHODS: In this retrospective cohort study we evaluated proteinuria as a time-varying covariate using urine dipstick protein values at 6 month intervals post-transplant. The primary outcome was the occurrence a major cardiovascular event (MACE). Univariate and multivariate time varying Cox model was used. RESULTS: 579 patients were included in the final cohort. 120 episodes of MACE were documented in 98 patients. Time varying proteinuria was associated with MACE by univariate and multivariate analysis (HR 2.63, 95% CI 1.76-3.93, p < 0.001) and (HR 2.33, 95% CI 1.53-3.54, p < 0.001). Reduction of proteinuria to normal was associated with reduced risk of MACE compared with active proteinuria (HR 0.44, 95% CI 0.28-0.69, p < 0.001) and (HR 0.47, 95% CI 0.3-0.76, p = 0.002) for univariate and multivariate analyses. Exposure to proteinuria for more than 1 year was significantly associated with an increased risk of MACE for univariate and multivariate analysis (HR 2.33, 95% CI 1.48-3.68, p < 0.001) and (HR 2.18, 95% CI 1.37-3.45, p = 0.002) respectively, in comparison to exposure of less than 1 year. CONCLUSION: These findings may suggest that we should consider applying clinical interventions that are known to reduce cardiovascular morbidity in these patients.
BACKGROUND:Proteinuria is common in kidney transplant recipients and has been established as a risk factor for graft-loss and mortality. In the general population, proteinuria has also been tied to a higher risk of cardiovascular disease. There is limited data exploring the association between changes in proteinuria over time and cardiovascular disease in kidney transplant recipients. METHODS: In this retrospective cohort study we evaluated proteinuria as a time-varying covariate using urine dipstick protein values at 6 month intervals post-transplant. The primary outcome was the occurrence a major cardiovascular event (MACE). Univariate and multivariate time varying Cox model was used. RESULTS: 579 patients were included in the final cohort. 120 episodes of MACE were documented in 98 patients. Time varying proteinuria was associated with MACE by univariate and multivariate analysis (HR 2.63, 95% CI 1.76-3.93, p < 0.001) and (HR 2.33, 95% CI 1.53-3.54, p < 0.001). Reduction of proteinuria to normal was associated with reduced risk of MACE compared with active proteinuria (HR 0.44, 95% CI 0.28-0.69, p < 0.001) and (HR 0.47, 95% CI 0.3-0.76, p = 0.002) for univariate and multivariate analyses. Exposure to proteinuria for more than 1 year was significantly associated with an increased risk of MACE for univariate and multivariate analysis (HR 2.33, 95% CI 1.48-3.68, p < 0.001) and (HR 2.18, 95% CI 1.37-3.45, p = 0.002) respectively, in comparison to exposure of less than 1 year. CONCLUSION: These findings may suggest that we should consider applying clinical interventions that are known to reduce cardiovascular morbidity in these patients.
Authors: Dana Bielopolski; Ruth Rahamimov; Boris Zingerman; Avry Chagnac; Limor Azulay-Gitter; Benaya Rozen Zvi Journal: Front Med (Lausanne) Date: 2021-04-12
Authors: Tássia Louise Sousa Augusto de Morais; Karla Simone Costa de Souza; Mabelle Alves Ferreira de Lima; Maurício Galvão Pereira; José Bruno de Almeida; Antônio Manuel Gouveia de Oliveira; Karine Cavalcanti Mauricio Sena-Evangelista; Adriana Augusto de Rezende Journal: PLoS One Date: 2022-08-04 Impact factor: 3.752