engleski

Metabolic disorders in renal transplant recipients - an experience from a tertiary care center in Croatia

INTRODUCTION: Advancements in immunosuppressive treatment of renal transplant recipients significantly increased graft and patient survival and significantly lowered the incidence of rejection crises. Efforts to increase long term patient and graft survival are directed to the prevention and treatment of cardiovascular diseases, because they are the leading cause of mortality in these patients. Traditional risk factors for the development of cardiovascular diseases (e.g. arterial hypertension, posttransplant diabetes mellitus and metabolic lipid disorder) are up to fifty times more often among renal transplant recipients than in the general population. The goal of this research was to analyze the frequency of the above mentioned metabolic disorders in renal transplant recipients, to analyze the impact of applied immunosuppressive therapy on the manifestation of the earlier mentioned metabolic disorders, and finally, to analyze the applied antihypertensive therapy. SUBJECTS AND METHODS: We analyzed 53 patients, who underwent renal transplantation in KBC Rijeka during a follow-up of two years. Fourteen patients (29.6%) had glomerulonephritis as the primary kidney disease ; 10 patients (18, 87%) had polycystic kidney disease ; 7 patients (13, 21%) had interstitial nephritis ; 5 patients (18.5%) had nefroangiosclerosis ; 4 patients (7, 55%%) had diabetic nephropathy, and 13 patients (24, 53%) had other diseases RESULTS: We analyzed a total of 53 patients, 58.5% were male. The average age was 49.8±11.3 (range from 27 to 72 years). Dialysis treatment before transplantation lasted on average 56.0±41.9 months. All patients received triple immunosuppressive therapy including a calcineurin inhibitor/MMF/corticosteroids and induction with IL- 2 receptor blockers (daclizumab or basiliximab). Thirty-three patients (62%) were treated with tacrolimus and 20 (38%) with cyclosporine. The average values of creatinine were 144, 92±46, 49. Eighteen patients (34%) had creatinine lower than 120 mmol/L, and thirty five patients (66%) had a level higher than 120 mmol/L. After transplantation, 49 patients (92.5%) were treated because of arterial hypertension (we took as the criterion for defining arterial hypertension a systolic blood pressure greather than 140 mmHg and a diastolic pressure greather than 90 mmHg or the routine use of anti-hypertension therapy.). Patients receiving cyclosporine had a significantly higher incidence of arterial hypertension (AH) compared with patients on tacrolimus (p=0.025). Among the patients who had a serum creatinine level higher than 120 mmol/L thirty-two patients (65, 3%) had hypertension. Nine (17%) patients achieved the target blood pressure (< 130/80 mmHg). Eight (16.32%) patients were treated with one drug, 24 (48.98%) with two, 15 (30.61%) with three and 2 (4, 09%) patients with more than three antihypertensive drugs. Only four patients did not take any antihypertensive medication. The most often used antihypertensive drugs were calcium channel blockers (40.4% patients), β-blockers (26.6%), and RAS inhibitors (9.2% patients received ACE inhibitors and 16.5% ARB). In six (11.3%) patients posttransplant diabetes mellitus developed and 21 (39.62%) patients were treated because of metabolic lipid disorder. CONCLUSION: In order to identify patients at higher risk for the development of cardiovascular disease in time, it is essential that kidney transplant recipients undergo regular controls of graft function, blood pressure, and metabolic parameters. A good graft function is important to increase the quality of life and to decrease the mortality of renal transplant recipients.

Cardiovascular Diseases; Diabetes Mellitus; Dyslipidemias; Hypertension; Kidney Transplantation

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