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De novo major cardiovascular events in kidney transplant recipients: a comparative matched cohort study

Authors
Kim, Ji EunPark, JinaPark, SehoonYu, Mi-YeonHa Baek, SeonPark, Sang HyunHan, KyungdoKim, Yong ChulKim, Dong KiOh, Kook-HwanJoo, Kwon WookKim, Yon SuLee, Hajeong
Issue Date
Apr-2022
Publisher
Oxford University Press
Keywords
cardiovascular risk; end-stage kidney disease; kidney transplantation; major cardiovascular events; mortality
Citation
Nephrology Dialysis Transplantation
Indexed
SCIE
SCOPUS
Journal Title
Nephrology Dialysis Transplantation
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/60992
DOI
10.1093/ndt/gfac144
ISSN
0931-0509
Abstract
Background Although cardiovascular disease is known to be one of the leading causes of death after kidney transplantation (KT), evidence on the risk difference of de novo major adverse cardiovascular events (MACEs) in kidney transplant recipients (KTRs) compared with that in dialysis patients or the general population (GP) remains rare. Methods We identified KTRs using the nationwide health insurance database in South Korea and then 1:1 matched them with the dialysis and GP controls without a pre-existing MACE. The primary endpoint was defined as de novo MACEs consisting of myocardial infarction, coronary revascularization and ischemic stroke. The secondary endpoints were all-cause mortality and death-censored graft failure (DCGF) in KTRs. Results We included 4156 individuals in each of the three groups and followed them up for 4.7 years. De novo MACEs occurred in 3.7, 21.7 and 2.5 individuals per 1000 person-years in the KTRs, dialysis controls and GP controls, respectively. KTRs showed a lower MACE risk {adjusted hazard ratio (aHR) 0.16 [95% confidence interval (CI) 0.12–0.20], P < .001} than dialysis controls, whereas a similar MACE risk to GP controls [aHR 0.81 (95% CI 0.52–1.27), P = .365]. In addition, KTRs showed a similar MACE risk compared with the GP group, regardless of age, sex and the presence of comorbidities, including hypertension, diabetes and dyslipidemia. Among KTRs, de novo MACEs were associated with an increased risk of all-cause mortality, but not with DCGF. Conclusions De novo MACEs in KTRs were much lower than that in dialysis patients and had a similar risk to the GP, but once it occurred it caused elevated mortality risk in KTRs.
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