P49
CONVENTIONAL CARDIOVASCULAR RISK FACTORS, SERUM ALBUMIN AND
PHOSPHATE PREDICT REDUCED SURVIVAL AND CARDIOVASCULAR EVENTS
FOLLOWING RENAL TRANSPLANT ASSESSMENT
Campbell, N1, Patel, RK1,2, Stevens, KK1,2, Johnston N1, Gillis, K1,2, Taylor, AHM1,2,
Kingsmore, DB2, Clancy, MJ2, Jardine, AG1,2, Mark, PB1,2
1.
Institute of Cardiovascular and Medical Sciences, University of Glasgow
2.
Glasgow Renal and Transplant Unit, Western Infirmary, Glasgow
INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of death in patients
with end stage renal disease (ESRD) including following successful renal transplantation, with
death with a functioning graft often the commonest cause of graft loss. One aim of
cardiovascular screening is to identify patients with remediable risk factors for cardiovascular
death, to minimise the risk to the patient and maximise utility of the graft. We studied the longterm outcomes in patients undergoing cardiovascular assessment to ascertain risk factors for
premature death and cardiovascular events following transplant assessment.
METHODS: Patients were studied during the period 2002-2007 with cardiac assessment
performed in parallel with transplant assessment. Cardiac function was assessed using cardiac
magnetic resonance (CMR). Demographic information and clinical history were recorded at the
time of CMR. Laboratory results were collected from bloods collected as part of dialysis or
chronic kidney disease (CKD) care during the month preceding assessment. Time to
transplantation, major adverse cardiovascular events (MACE) and death were collected using
the electronic patient record in August 2013.
RESULTS: 441 patients were studied (66.7% male; mean age 52.8, SD 11.5). At the time of
assessment 50.6% were on haemodialysis, 27.9% on peritoneal dialysis and 21.5% had CKD
stage 5 not on dialysis. During follow up there were 197 deaths. Compared to survivors, patients
who died during follow up were older (mean age 55.9 vs. 50.3 years p<0.001), more likely to be
diabetic (38.1 vs. 15.2%, p<0.001), have pre-existing ischaemic heart disease (IHD) (27.6 vs.
14.8%, p=0.001), have left ventricular hypertrophy (LVH) (72.1 vs. 62.3%, p<0.05) or systolic
dysfunction (23.4 vs. 15.6%, p<0.05), and have lower haemoglobin (11.2 vs. 11.6g/dL, p<0.05)
and albumin (36.8 vs. 38.8 g/L, p<0.001). In multivariate model, significant independent
predictors of reduced survival were diabetes, low albumin and older age, with receiving a
transplant during follow up associated with reduced risk. In similar analyses looking at
predictors of MACE during follow up, patients who experienced a MACE were older (mean age
55.9 vs. 50.3 p<0.001), had higher serum phosphate (1.78 vs. 1.62 mmol/L, p<0.05) and with a
higher prevalence of diabetes (36.4 vs. 20.8%, p<0.001), IHD (34.1 vs. 14.8%, p<0.001) and
left ventricular dysfunction (29.5 vs. 14.7%, p<0.05) but not LVH. Diabetes, prior IHD and
serum phosphate were independent predictors of MACE with transplantation being protective.
224 patients underwent renal transplantation. There were 47 post-transplant deaths and 47 posttransplant MACEs. Using data at baseline assessment, independent predictors of post transplant
death were age and diabetes, and post transplant MACE were serum phosphate and diabetes.
CONCLUSION: Pre-exiting cardiovascular risk factors such as age, diabetes, IHD and left
ventricular abnormalities predict patients at risk of reduced survival. Serum albumin is also a
predictor of reduced survival. It is a potentially modifiable risk factor and may reflect
malnutrition or inflammation. Predictors of cardiovascular disease on the transplant list or post
transplantation include diabetes, age, and left ventricular dysfunction. Serum phosphate
represents an additional non-traditional biomarker or therapeutic target for reduction in
cardiovascular risk.