Renal transplant dysfunction -: importance quantified in comparison with traditional risk factors for cardiovascular disease and mortality

Background. Renal transplant recipients (RTR) mainly die of premature cardiovascular disease. Traditional cardiovascular disease risk factors are prevalent in RTR. Additionally, non-traditional risk factors seem to contribute to the high risk. The impact of renal dysfunction was compared with traditional risk factors for cardiovascular morbidity and mortality in 1052 placebo-treated patients of the ALERT trial. Methods. All patients were on cyclosporine-based immunosuppressive therapy, follow-up was 5-6 years and captured endpoints included cardiac death, non-cardiovascular death, all-cause mortality, major adverse cardiac event (MACE), non-fatal myocardial infarction (MI) and stroke. Results. A calculated 84 mu mol/l increase in serum creatinine was needed to double the risk for cardiac death, an increase of 104 mu mol/l to double the risk for non-cardiovascular death and an increase of 92 mu mol/l to double the risk for all-cause mortality. MACE risk was doubled if serum creatinine was elevated by 141 mu mol/l, age was increased by 23 years, or LDL-cholesterol by 2 mmol/l. Diabetes increased the incidences of cardiac death, all-cause mortality, MACE, stroke and non-fatal MI. A serum creatinine increase of similar to 130 mu mol/l, or similar to 20 years increase in age was calculated as similar in risk for cardiac death, all-cause mortality and MACE, and comparable to risk of diabetes in RTR. Conclusion. An increase in serum creatinine of 80-100 mu mol/l doubles the risk for cardiac death, non-cardiovascular death and all-cause mortality in RTR. An increase of 130 mu mol/l in serum creatinine or similar to 20 years increase in age is comparable to risk of diabetes.