Evaluation of arterial stiffness and pulse wave reflection for cardiovascular risk assessment in diabetic and nondiabetic kidney transplant recipients

Evidence demonstrates that cardiovascular risk reduces after kidney transplantation, but is still a major cause of death. With increasing inclusion of diabetic patients for kidney transplantation, the evaluation of cardiovascular disease in this population becomes more important. We compared arterial stiffness and pulse wave reflection as well as other cardiovascular risk factors in kidney transplant patients with and without diabetes mellitus. One hundred kidney transplant recipients, including 33 diabetic patients, were evaluated for their renal-cardiovascular risk factors, including blood pressure, lipids, glucose control, homocysteine, and arterial stiffness indexes. The tests were repeated after 1 year in 47 individuals. There was no significant difference in pulse wave velocity [PWV] between the diabetic and nondiabetic groups, despite a greater augmentation index [AI] in the diabetic group [20.5 +/- 2.3 versus 13.1 +/- 2.2]. Multivariable analysis revealed that diabetes mellitus was a significant determinant for AI independently of age, blood pressure, posttransplant time, gender, and glomerular filtration rate [R2 = 39%]. Repeated test after 1 year demonstrated a significant reduction in the carotid-femoral PWV [P = .03] and systolic blood pressure [P = .007]. In contrast to nontransplant groups, AI was significantly greater in diabetic kidney transplant patients compared to their nondiabetic counterparts, despite a comparable PWV. However, carotid-femoral PWV improved after 1 year. These may reflect progressive ventricular and large arterial function improvement despite remained small arterial defects after transplantation. It also suggests potential role of arterial evaluation in risk assessment among kidney transplant patients

Arterial stiffness in kidney transplant recipients an overview of methodology and applications

Cardiovascular disease is still a major cause of mortality in kidney transplant patients. This is partially attributed to the nonclassic cardiovascular risk factors including arterial stiffness, an established independent predictor of mortality in several patient populations. An extensive search was performed to review the evolution process of the method for arterial stiffness assessment and sphygmology and their applications in chronic kidney disease before and after kidney transplantation. Despite a marked change in methodology from the ancient medical practice to the current modern medicine, noninvasive assessment of arterial stiffness is still based on pulse analysis. Currently, pulse wave velocity, augmentation index, and pulse wave reflection are preferred indexes for arterial stiffness. Increased arterial stiffness has been reported in diabetes mellitus, hypertension, chronic kidney disease, cardiovascular disease, and elderly, and reduction of arterial stiffness is a key element for efficacy of the treatment and mortality reduction. Noninvasive assessment of arterial stiffness is suggested as a part of clinical assessment for kidney transplant recipients and donors and facilitates defining high-risk patients for development of cardiovascular disease. A combination of techniques is recommended for this purpose