■冠状动脉钙化评分(CACS)和腹主动脉钙化评分(AACS)都是血管僵硬的公认标志物,和以前的研究表明,较高的CACS是慢性肾脏病(CKD)进展的危险因素。然而,移植前CACS和AACS对肾移植患者心血管和肾脏结局的影响尚未确定.
■我们纳入了来自KoreaN队列研究的944名肾移植受者,用于肾移植患者(KNOW-KT)队列的结果,并将他们分为三组(低,中等,和高)根据基线CACS(0,0<和≤100,>100)和AACS(0,1-4,>4)。低(0)中等(0<和≤100),高(>100)CACS组分别由462、213和225名患者组成,分别。同样,低(0),中等(1-4),高(>4)AACS组包括638、159和147例患者,分别。主要结局是心血管事件的发生。次要结局是全因死亡率和复合肾脏结局,其中包括>50%的估计肾小球滤过率和移植物损失下降。Cox回归分析用于研究基线CACS/AACS与结局之间的关联。
■高CACS组(N=462)面临明显更高的心血管结局风险(调整后的风险比[aHR],5.97;95%置信区间[CI],2.01-17.7)和全因死亡率(AHR,2.74;95%CI,1.27-5.92)与低CACS组(N=225)相比。同样,高AACS组(N=638)的心血管结局风险升高(AHR,2.38;95%CI,1.16-4.88)。此外,在预测模型中加入CACS改善了心血管结局的预测指标.然而,CACS和AACS组的肾脏结局风险无差异.
■移植前动脉钙化,以高CACS或AACS为特征,是肾移植患者心血管结局和死亡率的独立危险因素。
动脉钙化,钙在动脉壁中的积累,血管僵硬度,血管弹性的丧失会导致心血管疾病的发展。患有慢性肾病和接受透析的患者血管钙化的风险大大增加。即使在肾移植后肾功能恢复后,血管钙化和随后的心血管疾病的患病率仍然很高.冠状动脉钙化评分和腹主动脉钙化评分都是血管钙化的公认标志物。然而,移植前血管钙化评分对肾移植患者心血管和肾脏结局的影响尚未确定.当我们分析944名韩国肾移植患者时,两种血管钙化评分均与肾移植后的心血管结局显著相关,但与肾脏结局无关.我们还证明,增加冠状动脉钙化评分可使肾移植结果的预测性能略有改善。我们的研究结果表明,移植前冠状动脉钙化评分和主动脉钙化评分筛查在肾移植后结局的风险分层中具有潜在作用。
UNASSIGNED: Coronary artery calcification score (CACS) and abdominal aortic calcification score (AACS) are both well-established markers of vascular stiffness, and previous studies have shown that a higher CACS is a risk factor for chronic kidney disease (CKD) progression. However, the impact of pretransplant CACS and AACS on cardiovascular and renal outcomes in kidney transplant patients has not been established.
UNASSIGNED: We included 944 kidney transplant recipients from the KoreaN cohort study for Outcome in patients With Kidney Transplantation (KNOW-KT) cohort and categorized them into three groups (low, medium, and high) according to baseline CACS (0, 0 < and ≤100, >100) and AACS (0, 1-4, >4). The low (0), medium (0 < and ≤ 100), and high (>100) CACS groups each consisted of 462, 213, and 225 patients, respectively. Similarly, the low (0), medium (1-4), and high (>4) AACS groups included 638, 159, and 147 patients, respectively. The primary outcome was the occurrence of cardiovascular events. The secondary outcomes were all-cause mortality and composite kidney outcomes, which comprised of >50% decline in the estimated glomerular filtration rate and graft loss. Cox regression analysis was used to investigate the association between baseline CACS/AACS and outcomes.
UNASSIGNED: The high CACS group (N = 462) faced a significantly higher risk for cardiovascular outcomes (adjusted hazard ratio [aHR], 5.97; 95% confidence interval [CI], 2.01-17.7) and all-cause mortality (aHR, 2.74; 95% CI, 1.27-5.92) compared to the low CACS group (N = 225). Similarly, the high AACS group (N = 638) had an elevated risk for cardiovascular outcomes (aHR, 2.38; 95% CI, 1.16-4.88). Furthermore, the addition of CACS to prediction models improved prediction indices for cardiovascular outcomes. However, the risk of renal outcomes did not differ among CACS or AACS groups.
UNASSIGNED: Pretransplant arterial calcification, characterized by high CACS or AACS, is an independent risk factor for cardiovascular outcomes and mortality in kidney transplant patients.
Arterial calcification, accumulation of calcium in the arterial walls, vascular stiffness, and loss of elasticity of blood vessels can contribute to the development of cardiovascular diseases. Patients with chronic kidney disease and those undergoing dialysis have a considerably increased risk of vascular calcification. Even after kidney transplantation when kidney function has been restored, the prevalence of vascular calcification and subsequent cardiovascular disease remains high. Coronary artery calcification score and abdominal aortic calcification score are both well-established markers of vascular calcification. However, the impact of pretransplant vascular calcification scores on cardiovascular and renal outcomes in kidney transplant patients has not been established. When we analyzed 944 Korean kidney transplant patients, both vascular calcification scores were significantly associated with cardiovascular outcomes after kidney transplantation, but were not associated with renal outcomes. We also demonstrated that the addition of coronary artery calcification scores led to a modest improvement in the prediction performance for kidney transplant outcomes. Our findings suggest a potential role of pretransplant screening of coronary calcification scores and aortic calcification scores in risk stratification for post-kidney transplant outcomes.