Chronic kidney disease is associated with increased arterial stiffness. Correction of the uremic milieu by kidney transplantation may be improve arterial stiffness. However, the results from clinical studies are not uniformly convincing. This could be related to small sample size of studies, heterogeneity in methods and timing of assessment of arterial stiffness after transplantation. The objective of the present study is to measure the impact of renal transplantation on the reduction of arterial stiffness.Design and method:
Observational studies and randomized controlled trials with measurements of arterial wave velocity (PWV) were extracted from MEDLINE, EMBASE, COCHRANE LIBRARY, and Web of Science from their inception to January 2016. Two reviewers independently identified eligible studies comparing PWV before and after kidney transplantation and extracted data including population characteristics, interventions and outcomes.Results:
11 studies with 408 subjects were available for comparing pre- to post-transplant PWV. There was a mean change of PWV by -1.28 m/s (95% CI, - 2.01 to - 0.55) post-transplantation (I2 = 72 %). When subgroup analysis was performed only for studies that had assessed aortic PWV (5 studies, 163 patients), there was a non-significant mean changes of PWV by -0.74 m/s (95% CI, -1.49 to 0.02) post-transplantation (I2 = 61%) (FIGURE). The subgroup analysis of the studies with brachial-ankle PWV (BA-PWV), which included 4 studies and 168 patients, showed a significant reduction in PWV by -2.48 m/s (95% CI, - 4.36 to - 0.60) (I2 = 84 %). Limiting analysis to the studies that have measured BA-PWV after at least 3 months of transplantation (3 studies, 151 patients) showed similar results but reduced heterogeneity (I2 = 13%).Conclusions:
There is a significant reduction in overall PWV after kidney transplantation. There was a great heterogeneity in the among studies. Further analysis is required to examine the importance of changes in different vascular beds taking into account changes in blood pressure.