Association of vascular risk factors with carotid intima media thickness after kidney transplant

Background. Vascular risk remains the greatest cause of mortality after kidney transplant (KTX). Carotid intima media thickness (CIMT) has not been studied after KTX. We have analyzed a cross section of KTX recipients to determine which risk factors best correlate with CIMT, representing vascular risk. Methods. All recipients 6 or more months after KTX with estimated glomerular filtration rate (GFR) ≥30 mL/min were invited to participate. Biomarkers of vascular risk were compared with CIMT. Results. A total of 342 recipients (192 men/150 women) with mean age of 52.3±0.6 years (±standard error of the mean) were studied 5.9±0.3 years since KTX (range: 0.5-33.7 years). Diabetes (P<0.01), smoking (P=0.01), and donor status (deceased vs. living) (P=0.04) were associated with CIMT. Age (P<0.0001), body mass index (BMI, P=0.0026), systolic blood pressure (P=0.0013), and pulse pressure (P<0.0001) were positively and diastolic pressure was negatively correlated with CIMT (P=0.0002) and pulse pressure (P=0.007). In multivariate analysis, race/ethnicity, GFR, as well as age, BMI, diabetes status, systolic and diastolic blood pressures, and pulse pressure were all independently associated with CIMT (P<0.05). There was no correlation between CIMT and lipids, homocysteine, high-sensitive C-reactive protein, 25-hydroxyvitamin D, or parathyroid hormone (PTH). Conclusions. In the largest study of CIMT after KTX, diastolic blood pressure was negatively correlated with vascular risk, whereas age, diabetes, BMI, systolic blood pressure, race/ethnicity, and GFR independently correlated with CIMT after KTX confirming the value of CIMT as a noninvasive means to assess vascular risk and factors unique to this patient population.