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Therapy Insight: management of cardiovascular disease in the renal transplant recipient

Nature Clinical Practice Nephrology volume 2, pages 514–526 (2006)Cite this article

Abstract

Cardiovascular disease causes the deaths of up to 50% of renal transplant recipients who have a functioning graft. As in other states of chronic kidney disease, both overload cardiomyopathy (chronic heart failure and left ventricular hypertrophy) and ischemic heart disease are evident; age and gender are important risk factors for both of these disorders. Potentially treatable risk factors include smoking, hyperlipidemia, diabetes and hypertension for ischemic heart disease, and anemia, hypertension and diabetes for cardiomyopathy. Although definitive evidence on the effectiveness of interventions is lacking, it seems reasonable to treat renal transplant recipients as patients at the highest risk of cardiovascular disease. Aggressive targeting of lifestyle factors, blood pressure, cholesterol and sugar regulation is likely to have a major impact on patient and graft survival and should be initiated well before transplantation. Maintenance of hemoglobin with erythropoietic agents is controversial but might improve quality of life. Although immunosuppressive agents have distinct effects on cardiovascular risk factors, the impact on outcomes is impossible to predict on the basis of current data, and no firm recommendations can be made.

Key Points

  • The incidence of cardiovascular disease among renal transplant recipients is 3–4-fold greater than that among controls, with congestive heart failure, left ventricular hypertrophy and ischemic heart disease accounting for the greatest relative increase

  • Few trials have specifically addressed management of cardiovascular disease in renal transplant recipients, but some data can be extrapolated from studies of other patient populations

  • Risk factors for cardiovascular disease in renal transplant recipients might include age, male gender, diabetes, low hemoglobin level and a cadaveric kidney donor

  • Treatment of modifiable risk factors such as smoking, hyperlipidemia, diabetes, hypertension and anemia should be initiated well before transplantation

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Figure 1: Prevalence of cardiovascular disease in patients with renal disease.
Figure 2: Causes of cardiac disease in chronic kidney disease.
Figure 3: Adjusted relative risk of de novo chronic heart failure according to hemoglobin quartile in renal transplant recipients (n = 638).

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  1. assistant professor of medicine at the University of Manitoba, Winnipeg, Manitoba

    Claudio Rigatto

  2. University Research Professor at Memorial University of Newfoundland, St John's, Newfoundland, Canada

    Patrick Parfrey

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Correspondence to Claudio Rigatto.

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Rigatto, C., Parfrey, P. Therapy Insight: management of cardiovascular disease in the renal transplant recipient. Nat Rev Nephrol 2, 514–526 (2006). https://doi.org/10.1038/ncpneph0253

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