Traditional cardiovascular risk factors as clinical markers after kidney transplantation

Renal allograft survival has substantially increased during the last 2 decades. Nonetheless, death with a functioning graft is still the most common cause of renal graft loss after the first year, with cardiovascular disease (CVD) being the most common cause of patient death. Cardiovascular morbidity and mortality in patients who undergo renal transplantation are dramatically increased compared with the general population. Despite the description of new CVD risk factors and markers, modification of conventional risk factors for CVD may still be important in the care of patients who undergo renal transplantation. The objective of this review is to analyze traditional risk factors for CVD and define clinical markers for high-risk recipients. Clinical markers include unmodifiable risk factors such as male sex and old age. Presence of CVD before transplantation represents an important risk factor in these patients. Similarly, nephrosclerosis as cause of primary renal disease implies a worse pretransplant vascular state and a high-risk of cardiovascular events. Modifiable risk factors include hyperlipemia and hypertension, which have a high prevalence after transplantation. Posttransplant diabetes may have a role in the development of CVD, although it is difficult to obtain a reliable estimate of the incidence of diabetes because of the lack of standardized definition. Development of persistent proteinuria is an independent risk factor for increased mortality and especially cardiovascular morbidity and mortality, as it is the general population with essential hypertension or diabetes mellitus. Early renal dysfunction is also a marker not only of worse graft survival but also worse patient survival. Despite recent advances in the prolongation of patient and graft survival, patients who undergo transplantation die prematurely from accelerated CVD. Widespread adoption of simple clinical markers could help prolong graft and patient survival through prevention of CVD.