Obesity and cardiac risk after kidney transplantation: experience at one center and comprehensive literature review.
Obesity and cardiac risk after kidney transplantation: experience at one center and comprehensive literature review.
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DOI：
10.1097/tp.0b013e31817ef0f9
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发表时间：
2008-07-27
期刊：
影响因子：
6.2
通讯作者：
Brennan DC
中科院分区：
文献类型：
--
作者：
Lentine KL;Rocca-Rey LA;Bacchi G;Wasi N;Schmitz L;Salvalaggio PR;Abbott KC;Schnitzler MA;Neri L;Brennan DC
肥胖对肾移植受者心脏的影响还没有很好的描述。我们研究了1991-2004年在一个中心的1,102例肾移植受者中移植时的体重指数（BMI）与移植后心脏风险的关系。通过Kaplan-Meier方法估计移植后充血性心力衰竭（CHF）、房颤（AF）、心肌梗死（MI）和这些心脏诊断的复合疾病的累积发生率。通过考克斯回归模型建立BMI增量与心脏风险的双变量（风险比，HR）和协变量校正（aHR）关系。我们还系统地回顾了BMI和移植后心脏事件的文献。在当地数据中，任何心脏病诊断的5年累积发生率从最低BMI四分位数到最高BMI四分位数从8.67%上升到29.35%（P=0.02），主要由CHF和AF增加驱动。相反，MI的发生率在BMI四分位数之间没有差异（P=0.56）。BMI每增加5 U，预测心脏复合终点的风险增加26%（HR 1.26，95% CI 1.06 - 1.48 2.14，P=0.008），协变量校正后，这种关系仍具有显著性（aHR 1.19，95% CI 1.00 - 1.43，P=0.049）。BMI独立预测移植前心脏病和非糖尿病肾衰竭亚组的心脏风险。来自26篇原始文献的数据支持BMI是移植后CHF和AF的风险因素，而冠状动脉/缺血性结局的结果不一致，主要是阴性。移植时高BMI预示心脏风险增加，特别是CHF和AF。进一步研究应检查肥胖治疗是否可改变肾移植后的心脏风险。
The cardiac implications of obesity in kidney transplant recipients are not well-described. We examined associations of body mass index (BMI) at transplant with post-transplant cardiac risk among 1,102 renal allograft recipients at a single center in 1991-2004. Cumulative post-transplant incidences of congestive heart failure (CHF), atrial fibrillation (AF), myocardial infarction (MI), and a composite of these cardiac diagnoses were estimated by the Kaplan-Meier method. Bivariate (hazards ratio, HR) and covariate-adjusted (aHR) relationships of BMI increments with cardiac risk were modeled by Cox's regression. We also systematically reviewed the literature on BMI and cardiac events after transplant. In the local data, 5-year cumulative incidence of any cardiac diagnosis rose from 8.67% to 29.35% across the lowest to highest BMI quartiles (P=0.02), driven primarily by increases in CHF and AF. In contrast, the rate of MI did not differ by BMI quartile (P=0.56). Each 5 U BMI increase predicted 26 % higher risk of the cardiac composite (HR 1.26, 95% CI 1.06 −1.48 2.14, P=0.008), a relationship that persisted with significance after covariate adjustment (aHR 1.19, 95% CI 1.00 −1.43, P=0.049). BMI independently predicted cardiac risk in sub-cohorts with pre-transplant heart disease and with non-diabetic renal failure. Data from 26 original articles support BMI as a risk factor for post-transplant CHF and AF, whereas findings for coronary/ischemic outcomes are inconsistent and predominantly negative. High BMI at transplant predicts increased cardiac risk, especially of CHF and AF. Further research should examine whether obesity treatment modifies cardiac risk after kidney transplantation.