Cardiovascular disease (CVD) is the leading cause of death after renal transplantation (RT). Sex-specific differences in CVD in the general population are well known. The aim of this study was to evaluate sex-specific differences in prevalence and course of subclinical cardiovascular (CV) organ damage in RT recipients during the first year after RT.
Methods:
In a prospective longitudinal study, we enrolled 121 patients (male 64%, age 51 ± 15 years). CV risk factors, left ventricular mass index (LVMI), and pulse wave velocity (PWV) were assessed at time of RT and 1 year later.
Results:
Women showed less prediagnosed CVD and better blood pressure (BP) control, and were less likely to be treated with calcium channel blockers (CCBs). Despite similar transplant function, LVMI increased in women and decreased in men (p = 0.027). In multivariable analysis, changes in LVMI were independently associated with female sex and systolic BP. Importantly, women receiving CCBs showed a decrease in LVMI and PWV.
Conclusions:
Our findings indicate a sex-specific association between RT and changes in LVMI. CCBs seem to have a positive impact on CV risk after RT, especially in women. Further studies on the effect of sex and CCB use in RT recipients are warranted.
Get full access to this article
View all access options for this article.
References
1.
MelkA, BabitschB, Borchert MörlinsB, et al.Equally interchangeable?—How sex and gender affect transplantation. Transplantation, 2019; 103:1094.
2.
WolfeRA, AshbyVB, MilfordEL, et al.Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med, 1999; 341:1725.
3.
National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. United States renal data system. 2017 USRDS Annual data report: Epidemiology of kidney disease in the United States. 2017.
4.
KasiskeBL. Epidemiology of cardiovascular disease after renal transplantation. Transplantation, 2001; 72(6Suppl):S5.
5.
JardineA, GastonR, FellstromB, HoldaasH. Prevention of cardiovascular disease in adult recipients of kidney transplants. Lancet, 2011; 378:1419.
6.
MoscaL, BenjaminE, BerraK, et al.Effectiveness-based guidelines for the prevention of cardiovascular disease in women-2011 update: A guideline from the American Heart Association. J Am Coll Cardiol, 2011; 57:1404.
7.
MoscaL, Barrett ConnorE, WengerN. Sex/gender differences in cardiovascular disease prevention: What a difference a decade makes. Circulation, 2011; 124:2145.
8.
MoscaL, LinfanteA, BenjaminE, et al.National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation, 2005; 111:499.
9.
MelloniC, BergerJ, WangT, et al.Representation of women in randomized clinical trials of cardiovascular disease prevention. Circ Cardiovasc Qual Outcomes, 2010; 3:135.
10.
JochmannN, StanglK, GarbeE, BaumannG, StanglV. Female-specific aspects in the pharmacotherapy of chronic cardiovascular diseases. Eur Heart J, 2005; 26:1585.
11.
IsraniAK, SnyderJJ, SkeansMA, et al.Predicting coronary heart disease after kidney transplantation: Patient outcomes in renal transplantation (PORT) study. Am J Transplant, 2010; 10:338.
12.
VlachopoulosC, AznaouridisK, StefanadisC. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: A systematic review and meta-analysis. J Am Coll Cardiol, 2010; 55:1318.
13.
LevyD, GarrisonRJ, SavageDD, KannelWB, CastelliWP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham heart study. N Engl J Med, 1990; 322:1561.
14.
HimelmanRB, LandzbergJS, SimonsonJS, et al.Cardiac consequences of renal transplantation: Changes in left ventricular morphology and function. J Am Coll Cardiol, 1988; 12:915.
15.
RigattoC, FoleyRN, KentGM, GuttmannR, ParfreyPS. Long-term changes in left ventricular hypertrophy after renal transplantation. Transplantation, 2000; 70:570.
16.
IkäheimoM, LinnaluotoM, HuttunenK, TakkunenJ. Effects of renal transplantation on left ventricular size and function. Br Heart J, 1982; 47:155.
17.
PatelR, MarkP, JohnstonN, McGregorE, DargieH, JardineA. Renal transplantation is not associated with regression of left ventricular hypertrophy: A magnetic resonance study. Clin J Am Soc Nephrol, 2008; 3:1807.
18.
McGregorE, StewartG, RodgerRS, JardineAG. Early echocardiographic changes and survival following renal transplantation. Nephrol Dial Transplant, 2000; 15:93.
19.
BirdwellK, JaffeG, BianA, WuP, IkizlerT. Assessment of arterial stiffness using pulse wave velocity in tacrolimus users the first year post kidney transplantation: A prospective cohort study. BMC Nephrol, 2015; 16:93.
20.
Bachelet RousseauC, Kearney SchwartzA, FrimatL, FayR, KesslerM, BenetosA. Evolution of arterial stiffness after kidney transplantation. Nephrol Dial Transplant, 2011; 26:3386.
21.
WheltonP, CareyR, AronowW, et al.ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol, 2017; 71:e127.
22.
National Cholesterol Education Program (NCEP) Expert Panel onDetection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation, 2002; 106:3143.
23.
LeveyA, StevensL, SchmidC, et al.A new equation to estimate glomerular filtration rate. Ann Intern Med, 2009; 150:604.
24.
Bloomberg School of Public Health. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Inter, 2013; 3:1.
25.
Van BortelL, DuprezD, Starmans KoolM, et al.Clinical applications of arterial stiffness, task force III: Recommendations for user procedures. Am J Hypertens, 2002; 15:445.
26.
KrachtD, ShroffR, BaigS, et al.Validating a new oscillometric device for aortic pulse wave velocity measurements in children and adolescents. Am J Hypertens, 2011; 24:1294.
27.
WilliamsB, ManciaG, SpieringW, et al.2018 ESC/ESH guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European society of cardiology and the European society of hypertension: The task force for the management of arterial hypertension of the European society of cardiology and the European society of hypertension. J Hypertens, 2018; 36:1953.
28.
DevereuxRB, AlonsoDR, LutasEM, et al.Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings. Am J Cardiol, 1986; 57:450.
29.
LangR, BadanoL, Mor AviV, et al.Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American society of echocardiography and the European association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging, 2015; 16:233.
30.
IchiharaA, HayashiM, KouraY, TadaY, HirotaN, SarutaT. Long-term effects of intensive blood-pressure lowering on arterial wall stiffness in hypertensive patients. Am J Hypertens, 2003; 16:959.
31.
PeteiroJ, AlvarezN, CalviñoR, PenasM, RiberaF, Castro BeirasA. Changes in left ventricular mass and filling after renal transplantation are related to changes in blood pressure: An echocardiographic and pulsed Doppler study. Cardiology, 1994; 85:273.
32.
OpelzG, DöhlerB. Improved long-term outcomes after renal transplantation associated with blood pressure control. Am J Transplant, 2005; 5:2725.
33.
KlonerRA, SowersJR, DiBonaGF, GaffneyM, WeinM. Sex- and age-related antihypertensive effects of amlodipine. the amlodipine cardiovascular community trial study group. Am J Cardiol, 1996; 77:713.
MidtvedtK, HartmannA, FossA, et al.Sustained improvement of renal graft function for two years in hypertensive renal transplant recipients treated with nifedipine as compared to lisinopril. Transplantation, 2001; 72:1787.
NeatonJD, GrimmRH, PrineasRJ, et al.Treatment of mild hypertension study. final results. Treatment of mild hypertension study research group. JAMA, 1993; 270:713.
38.
ManteuffelM, WilliamsS, ChenW, VerbruggeR, PittmanD, SteinkellnerA. Influence of patient sex and gender on medication use, adherence, and prescribing alignment with guidelines. J Womens Health (Larchmt), 2014; 23:112.
39.
LauerMS, AndersonKM, LevyD. Separate and joint influences of obesity and mild hypertension on left ventricular mass and geometry: The Framingham heart study. J Am Coll Cardiol, 1992; 19:130.
40.
GlassockR, Pecoits FilhoR, BarberatoS. Left ventricular mass in chronic kidney disease and ESRD. Clin J Am Soc Nephrol, 2009; 4Suppl 1:S79.
41.
de SimoneG, DevereuxR, IzzoR, et al.Lack of reduction of left ventricular mass in treated hypertension: The strong heart study. J Am Heart Assoc, 2013; 2:e000144.
42.
LønnebakkenM, IzzoR, MancusiC, et al.Left ventricular hypertrophy regression during antihypertensive treatment in an outpatient clinic (the Campania salute network). J Am Heart Assoc, 2017; 6:e004152.
43.
GerdtsE, OkinP, de SimoneG, et al.Gender differences in left ventricular structure and function during antihypertensive treatment: The losartan intervention for endpoint reduction in hypertension study. Hypertension, 2008; 51:1109.
44.
HaywardCS, KellyRP. Gender-related differences in the central arterial pressure waveform. J Am Coll Cardiol, 1997; 30:1863.
45.
SmulyanH, AsmarRG, RudnickiA, LondonGM, SafarME. Comparative effects of aging in men and women on the properties of the arterial tree. J Am Coll Cardiol, 2001; 37:1374.
46.
MitchellG, PariseH, BenjaminE, et al.Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: The Framingham heart study. Hypertension, 2004; 43:1239.
HottaK, HaradaH, SasakiH, et al.Successful kidney transplantation ameliorates arterial stiffness in end-stage renal disease patients. Transplant Proc, 2012; 44:684.
49.
IgnaceS, UtescuM, De SerresS, et al.Age-related and blood pressure-independent reduction in aortic stiffness after kidney transplantation. J Hypertens, 2011; 29:130.
50.
DesjardinsM, Sidibé A, Fortier C, et al. Impact of kidney transplantation on aortic stiffness and aortic stiffness index. J Hypertens, 2019; 37:1521.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
