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Abstract: FR-PO834

Risk Factors for Heart Failure Hospitalization in Kidney Transplant Recipients: Results From FAVORIT

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • McGrath, Martina M., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Claggett, Brian, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Bostom, Andrew, Rhode Island Hospital, Providence, Rhode Island, United States
  • Levey, Andrew S., Tufts Medical Center, Boston, Massachusetts, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States
  • Pfeffer, Marc A., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

The development of heart failure (HF) post kidney transplantation is associated with a higher risk of allograft failure and death. Using data from stable kidney transplant recipients (KTRs) enrolled in FAVORIT, we evaluated risk factors for HF hospitalization.

Methods

FAVORIT randomized 4,110 stable KTRs to either a high-dose or low-dose multivitamin (folate, B6, B12). HF hospitalizations were determined by review of discharge diagnoses. Stepwise Cox regression models with forwards selection (P<0.05 for entry) were fit to assess for independent risk factors of HF hospitalization events (candidate variables included age, sex, race, country, BMI, cardiovascular disease, diabetes, donor type, graft vintage, albuminuria, smoking, aspirin, statin, ACEi or ARB use; treatment assignment and eGFR were forced in the model).

Results

Of the 3,633 patients with complete data available, 115 patients (3.2%) experienced a HF hospitalization over a mean follow-up of four years (0.8 events per 100 patient years (95%CI 0.7-1.0)). The variables associated with a higher adjusted risk of HF events were albuminuria, older age, higher BMI, Black race (vs. non-Black), country (United States+Canada vs. Brazil), prior history of CV disease, and diabetes (Table 1).

Conclusion

In a post-hoc analysis of FAVORIT, we identified multiple independent risk factors for HF hospitalization. Some of these, such as BMI and albuminuria, may be modifiable by lifestyle modifications and newer drug therapies, which should be adequately tested in this high-risk population.

Risk factors for heart failure hospitalization among stable kidney transplant recipients
Baseline characteristicsBaseline measurementHazard Ratio per unit changeHazard Ratio95% Confidence
Interval
P
Urine albumin/creatinine ratio, mg/g53 [9, 101]per 10-fold log-unit1.761.40 to 2.22<0.001
eGFR ml/min/1.73m249 ±16per 10 ml/min/1.73m21.090.96 to 1.240.20
Age, years52 ±9per 10 years1.401.14 to 1.720.01
Black, n(%)630 (17%)Black (vs non-Black)1.671.09 to 2.550.02
USA+Canada participants, n(%)3,021 (83%)USA + Canada (vs Brazil)6.011.47 to 24.60.01
BMI, kg/m229 ±6Per 5 kg/m21.181.03 to 1.360.02
History of cardiovascular disease, n(%)729 (20%)History of cardiovascular disease (vs without)2.351.60 to 3.47<0.001
Diabetes, n(%)1,455 (40%)Diabetes (vs without)1.541.04 to 2.260.01
Randomized Treatment (Higher dose), n(%)1,825 (50%)Higher vs. lower dose0.860.60 to 1.240.35