Associations Among Cardio-Ankle Vascular Index, Carotid Intima-Media Thickness, and Fibroblast Growth Factor-21 Levels in Kidney Transplant Patients.

Background: Cardiovascular disease is the major cause of death in patients with chronic kidney disease, even after renal transplantation. Cardio-ankle vascular index (CAVI) provides an indicator of arterial stiffness, whereas fibroblast growth factor-21 (FGF-21) levels may provide a biomarker for atherosclerotic disease. We investigated the association between CAVI and FGF-21 and their relationships to carotid intima-media thickness (IMT) and other cardiovascular risk factors.

Methods: This study included 90 renal transplant patients. Data on CAVI, echocardiograms, homocysteine, high-sensitivity C-reactive protein, carotid IMT, FGF-21, and incidence of cardiovascular disease were collected and correlations were analyzed statistically.

Results: The mean CAVI was 7.51 ± 1.69. CAVI was significantly higher in older patients (mean age, 51.54 ± 9.92 vs 42.92 ± 11.20 years, P < .001) and was positively correlated with carotid IMT (r = 0.214, P = .050) and negatively with hemoglobin (r = -0.219, P = .044). There was no association between CAVI and FGF-21 or other parameters. FGF-21 was positively correlated with high-sensitivity C-reactive protein and negatively with renal function. The mean carotid IMT score was 0.57 ± 0.18. Scores were significantly higher in patients >60 years of age, with low cholesterol and high-density lipoprotein and high body mass index. Higher body mass index (P = .013) and carotid IMT (P < .001) were associated with more frequent cardiovascular events. Mean homocysteine levels remained >15 μmol/L and did not differ in those with or those without cardiac events.

Conclusions: This study demonstrates that cardiovascular risk factors remain after renal transplantation, despite normal arterial stiffness. Close cardiac monitoring and risk-factor modification are therefore recommended, even after successful renal transplantation.