www.renalandurologynews.com
SUMMER 2022
Post-Kidney Transplant MACE Predicts Diminished Survival Investigators report a 2.6-fold increased risk for long-term mortality RECENTLY REPORTED study find ings provide a detailed look at how a major adverse cardiovascular event (MACE) after kidney transplantation adversely affects survival and identify which patients are at elevated risk for MACE. Data also demonstrate that patients who receive a kidney transplant
nstable angina, myocardial infarc u tion (MI), stroke, heart failure, any coronary revascularization procedure and/or any cardiovascular death. A MACE occurred in 781 patients (2.6%) within the first 12 months of transplant surgery. Unstable angina occurred in 0.2%, heart failure in 0.3%, MI in 1.1%,
Survival After MACE Kidney transplant recipients who had a nonfatal major adverse cardiovascular event (MACE) within the first year after transplant surgery, compared with those who did not, had significantly lower 1-, 3-, 5-, and 10-year survival rates, a study found. n MACE
100 80
97.4% 80.5%
94.4% 70.2%
60
n No MACE
90.7%
78.4%
59.5% 38.6%
40 20 0
1 Year
3 Years
5 Years
ADPKD Tied to Lower MACE Risk In a study published in Kidney International Reports, investigators found that KTRs with autosomal domi nant polycystic kidney disease (ADPKD) have a more favorable MACE-free sur vival rate than patients with diabetes and other forms of kidney disease. In an ageand sex-matched analysis, KTRs with ADPKD had a significant 29% reduced risk for MACE after kidney transplanta tion compared with those with diabetic nephropathy and those without diabetes or ADPKD, Fouad T. Chebib, MD, of Mayo Clinic in Jacksonville, Florida, and colleagues reported.
Aspirin May Lower MACE Risk in CKD ASPIRIN MAY prevent major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD), according to study findings presented at the European Renal Association’s 59th Congress held in Paris, France, and virtually. The findings are from the International Polycap Study3 (TIPS3) study in which investigators randomly assigned 5713 individuals with and without CKD, but without previous cardiovascular (CV) disease, to receive aspirin, aspirin plus a polypill (con taining atenolol, ramipril, hydrochlo rothiazide, and simvastatin), a poly pill alone, or respective placebo. Of the 5713 participants, 983 had CKD, defined as an estimated glomerular filtration rate (eGFR) less than 60 mL/ min/1.73 m2. The primary outcome was MACE, which included non-fatal myo cardial infarction, non-fatal stroke, or CV-related death. Secondary outcomes included all-cause mortality. The mean follow-up duration was 4.6 years.
10 Years
Source: Anderson B et al. A population cohort analysis of English transplant centers indicates major adverse cardiovascular events after kidney transplantation. Kidney Int. Published online June 15, 2022.
are at lower MACE risk compared with those who remain on dialysis. In a study of 30,325 KTRs in England published in Kidney International, a MACE occurred in 781 within the first year of transplantation surgery. KTRs who had a non-fatal MACE within that timeframe had significantly decreased patient survival compared with KTRs who did not experience a MACE at 1 year (80.5% vs 97.4%), 3 years (70.2% vs 94.4%), 5 years (59.5% vs 90.7%), and 10 years (38.6% vs 78.4%). A nonfatal MACE within the first-year of transplant surgery was significantly associated with 2.6-fold increased risk for longterm mortality, Adnan Sharif, MBChB, MD, of Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom and colleagues reported. “Non-fatal MACE within the first year, regardless of the precise timing, was a powerful predictor of increased future mortality,” the investigators wrote. “Understanding MACE rates is important for service providers, health care professionals and kidney trans plant recipients themselves.” The investigators defined MACE broadly as any hospitalization for
the age-matched general population,” Dr Sharif’s team wrote. “Adequate counselling aside, strategies to predict and/or mitigate cardiovascular risk in the setting of kidney transplantation are urgently required.”
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coronary revascularization in 0.4%, stroke in 0.8%, and immediate cardiac death in 0.1% within the first 12 months after transplant surgery. The investiga tors noted that these rates are lower than rates reported in North America.
Sex and Age Differences Results also showed that men had a 20% higher risk for a MACE within 12 months than women. Compared with KTRs younger than 40 years, those aged 40-49, 50-59, and 60 years or older had a 2.4-, 4.3-, and 7.1-fold greater risk for an early MACE after kidney transplantation. Recipients of deceased donor vs living donor kidneys had a 37% higher 1-year MACE risk. Previous myocardial infarction, stroke, or angina was significantly associated with a 6.9-, 4.1-, and 2.6-fold increased risk of an early MACE, respectively. Diabetes at transplantation was sig nificantly associated with a 2.2-fold increased risk for a 1-year MACE after kidney transplantation. “Successful kidney transplantation reduces cardiovascular burden com pared to remaining on dialysis, but risk remains elevated compared to
Transplantation vs Dialysis In a Korean study published in Nephrology Dialysis Transplantation, investigators examined de novo MACE in KTRs compared with patients receiving dialysis. Using the South Korean nationwide health insurance database, they matched 4156 patients without a pre-existing MACE in each of 3 groups: KTRs, dialysis recipients, and the general population. Over 4.7 years of follow-up, de novo MACE occurred in 3.7, 21.7, and 2.5 individuals per 1000 person-years in the KTR, dialysis, and general popu lation groups, respectively. De novo MACE included myocardial infarction, revascularization, and ischemic stroke. The investigators noted that these rates are lower than those reported in Western populations. KTRs had a significant 84% lower risk for de novo MACE compared with patients on dial ysis, but a similar risk compared with the general population after adjusting for underlying comorbidities such as diabetes and hypertension, Hajeong Lee, MD, of Seoul National University Hospital and colleagues reported. This finding suggests that kidney transplan tation effectively reduces the risk of MACE compared with remaining on dialysis, according to Dr Lee’s team. ■
Aspirin vs placebo was associated with a 43% reduced risk for MACE. A total of 250 primary MACE occurred: 116 among aspirin recipi ents and 134 among placebo recipients, Johannes F.E. Mann, MD, from the University of Erlangen-Nürnberg and Munich General Hospitals in Germany, reported. Among patients with CKD, there were 65 primary MACE out comes: 26 in the 502 participants on aspirin and 39 in the 481 participants on placebo. Aspirin use in those with CKD was significantly associated with a 43% reduction in MACE risk. Death from any cause occurred in 312 participants, with 82 occurring in the CKD group. Aspirin use was signifi cantly associated with a 36% decreased risk for death compared with placebo. For all participants, the aspirin-polypill combination was significantly associated with a 31% decreased risk for MACE. Among patients with CKD, the combi nation treatment was significantly associ ated with a 63% and 51% decreased risk for MACE and death, respectively. ■
