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Abstract: TH-PO184

Effect of Renal Transplantation on Carotid Intimal Medial Thickness (CIMT), Left Ventricular Mass Index (LVMI), and CKD-MBD Markers: A Longitudinal Study

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Author

  • Mahajan, Sandeep, All India Institute of Medical Sciences, New Delhi, DELHI, India
Background

Various nontraditional risk factors (NTRFs) including serum markers of CKD-MBD (serum calcium, phosphorus, intact PTH, vitamin D & FGF-23) & increased LVMI have been implicated for high cardiovascular (CV) mortality in CKD. Renal transplant (RT) by correcting uremic milieu improves most NTRFs. However compared to general population, CV mortality remains high post RT. This could be due to new risk factors or legacy effect of previous CKD period. CIMT is marker of structural atherosclerosis & has been shown to decrease after correction of risk factors in some clinical settings. This prospective, longitudinal study in CKD 5D patients looks at any change in CIMT & LVMI post RT & their correlation with changes in CKD-MBD markers.

Methods

83 consecutive, eligible & consenting patients aged 18-65 years undergoing first live RT were enrolled. All investigations, CIMT & LVMI assessments were done at baseline (≤1 week prior to RT) & at 6 &12 months post RT. Patients with pre-transplant diabetes, established coronary/valvular heart disease & those having persistent eGFR <40 ml/min post RT were excluded

Results

74 patients completed study, 91.8% were male, mean age was 35.5+10.6 years & median dialysis vintage was 14 months. All were on MMF, steroids & calcineurin inhibitors. At baseline CIMT did not correlate with any of CKD-MBD parameters while LVMI correlated positively with FGF-23 (correlation coeffficent 0.57, p-value <0.001). There was a significant reduction in CIMT & LVMI at 6 & 12 months post RT & improvement some CKD-MBD markers (table). There was however no correlation between changes in CIMT & LVMI & changes in CKD-MBD markers

Conclusion

In low risk CKD-5D population we document a significant decline in CIMT & LVMI post RT. Though there was significant improvement in CKD-MBD markers post RT they did not correlate with change in CIMT & LVMI

ParameterBaseline6 month12 monthP-value
I vs II, I vs III
CIMT mm0.57±0.070.55±0.080.55±0.070.001, 0.001
LVMI g/m2181.9±14.4160.8±12149.3±13.6<0.001, <0.001
S. Calcium mg/dl9.2±1.49±0.89±0.70.16, 0.3
S. Phosphorus mg/dl5±1.62.9±0.83.3±0.6<0.001, <0.001
Intact PTH pg/dl median (range) 57.8 (9.3-1297.7)33 (3-297)12.9 (3-210)0.29, 0.01
25 (OH) Vit D ng/dl
median (range)
10.5 (4.9-52.6)10.5 (4.9-52.6)16.6 (3.9-38.2)0.54, 0.08
Intact FGF-23 pg/dl median (range)2649.2 (157.8-3244.2)72.2 (2.3-2481.3)68.6 (5.7-2939.5)<0.001, <0.001