Presence of subclinical atherosclerosis constitutes a risk factor for cardiovascular events. The aim is to describe the prevalence of subclinical carotid plaques in stable renal transplants and evaluate the variables associated with its progression.Design and method:
Between June and September 2011, consecutive kidney transplants with an estimated glomerular filtration rate (e-GFR) <60 ml/min/1.73 m2 and without previous cardiovascular events were included. At entry, carotid ultrasound and 24 h ambulatory blood pressure monitoring (ABPM) were performed and a serum sample to determinate interleukin 6 (IL-6), soluble tumor necrosis factor receptor 2 (sTNFR2) and intercellular adhesion molecule 1 (ICAM-1) levels was obtained. At 18 months of follow up, carotid ultrasound was repeated.Results:
A total of 100 kidney transplants were included. Demographic characteristics are summarized in table 1. Five patients were lost to follow up. In the basal and follow up carotid ultrasound there were 54% and 61% of patients showing at least one carotid plaque, respectively (p = 0.320). The number of carotid plaques increased during follow up in 27 out of 95 patients (28.4%). The mean number of carotid plaques per patient increased from 1.12 ± 1.44 to 1.43 ± 1.64 (p = 0.0001) and the progression of the number of carotid plaques was 0.2 ± 0.4 plaque/year. Recipient age (HR: 1.090, 95% CI: 1.009–1.177, p = 0.029) and reverse dipper pattern (HR: 5.757, 95%CI: 1.261–26.284, p = 0.024) were independent predictors of the presence of plaques at basal carotid ultrasound. Reverse dipper pattern (p = 0.003), 24 h SBP (p = 0.001) and basal IMT (p = 0.001) were independent predictors of progression of the number of carotid plaques at 18 months follow-up.Conclusions:
Hypertension and reverse dipper pattern evaluated by ABPM are predictors of presence and progression of carotid plaques in kidney transplants recipients.