Cardiovascular Risk Evaluated With the Use of Heartscore in Kidney Transplant Recipients—Three Years of Follow-up

• Heartscore estimates the risk of cardiovascular death based on data such as age, sex, smoking, hypertension, and cholesterol level or total cholesterol/HDL cholesterol ratio, and the result is presented in the form of a chart showing total absolute risk (current risk profile) and the share of modifiable factors.
• Mean cardiovascular risk evaluated with the use of Heartscore was lower in living-donor kidney transplant recipients than in deceased-donor kidney transplant recipients. Therefore, that transplantation method should be promoted.
• In our study, higher creatinine level and lower eGFR were associated with a higher cardiovascular risk in the 3rd year of follow-up.
• Cardiovascular risk scores in patients with kidney diseases should additionally account for eGFR.

BackgroundCardiovascular (CV) complications are the major cause of death in kidney transplant (KT) patients.MethodsDuring a 3-year follow-up, 112 KT recipients, from living (LD KTRs; n = 54), and deceased (DD KTRs; n = 58) donors, were assessed for 10-year risk of fatal CV events with the use of the Heartscore tool (www.heartscore.org). In post-KT months 6, 12, and 36, current and optimum (target) CV risks (CVRs) were estimated.ResultsCurrent risk was lower in the LD KTRs and remained stable. In DD KTRs, the risk was at the highest level in months 6 and 12 of follow-up and decreased in month 36. Change in CVR, ie, the difference between the current and target risk, was the highest in DD KTRs in month 36 of follow-up (P = .014). In the increased-CVR group, recipients were older (P < .01), primarily male (P = .08), and more frequently smokers (P < .01) and had a higher systolic blood pressure (P < .05) despite taking more hypotensive medicines (P < .01), and had higher total cholesterol (P < .01) and low-density lipoprotein (P < .01) levels. In this group, body mass index (BMI) was higher (P < .01) and metabolic syndrome was diagnosed significantly more often (P < .01). The high-risk group (estimated CVR, ≥5) was different also in longer durations of pre-transplantation dialysis (P < .05) and higher rates of CV episodes before transplantation (P < .05). In logistic regression, higher BMI and lower estimated glomerular filtration rate (eGFR) were the parameters strongly correlated with higher CVR.ConclusionsMean CVR applicable to all kidney transplant recipients was stable throughout the follow-up. Changes in the risk affected mainly DD KTRs. In months 6 and 12, CVR was the highest in this group and was substantially reduced in the 3rd year of follow-up, probably owing to medical interventions. In the high-CVR group, impaired function of the transplanted kidney was recorded. CVR scores in patients with renal conditions and after kidney transplantation should additionally account for eGFR.