4. Assessment of the risk of cardiovascular disease in asymptomatic patients with a transplanted kidney

Cardiovascular diseases are the main cause of morbidity and mortality in post-transplant patients [52]. The risk assessment of cardiovascular disease in asymptomatic patients with a transplanted kidney is of great practical importance because it allows the identification of patients at high risk for cardiovascular events, which further allows timely intervention before the disease develops. To assess the risk of cardiovascular disease in asymptomatic patients with a transplanted kidney, we can apply the scores used for assessment of cardiovascular risk in general population. The scores for the general population are the Systematic Coronary Risk

Evaluation SCORE system, the Prospective Cardiovascular Munster PROAM score system, and the National Cholesterol Education Program Adult Treatment Panel III NTEP ATP III [53]. The new risk assessment model is based on the Heart Score system (Systematic Coronary Risk Evaluation). The Heart Score Risk Card has been developed on the basis of large prospective studies in Europe and predicts the fatal outcomes of cardiovascular disease for 10 years. The

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Table 1. Heart score high risk map.


Table 1. Heart score high risk map.

is five times higher than in the general population. The main cause of ischemic heart disease is atherosclerosis of the coronary arteries, and in patients with transplanted kidney there are many risk factors that contribute to atherosclerosis: elevated arterial blood pressure, lipid metabolism disorder, microinflammation, hyperhomocysteinemia, oxidative stress and sec-

In patients with a transplanted kidney, there is a high risk of sudden cardiac death. The main causes are coronary arterial heart disease, left ventricular hypertrophy, and reduced coronary perfusion. In patients with a transplanted kidney, the prevalence of coronary heart disease is

In all patients with ischemic heart disease, the following should be done: detailed anamnesis and physical examination, ECG at rest, blood biochemical analysis (lipids, glucose, creatinine, urea, hepatogram, complete blood count, uric acid, fibrinogen, hsCRP, etc.) echocardiographic examination, ergometric testing. In patients with transplanted kidney, the risk factors for the development of atherosclerosis should be controlled in the primary prevention and prevention of coronary artery disease development. In clinical practice, patients with acute myocardial infarction with elevation of ST connectors are using modern reperfusion therapy (thrombolysis or percutaneous coronary intervention). Medical treatment implies the use of anti-aging ther-

Valvular heart disease is common in patients with chronic dialysis. Current knowledge of heart valve disease (the evolution of pre-dialysis disease or the emergence of de novo diseases of the heart valve) in patients following kidney transplantation is scarce. In the literature, there are few data about heart rhythm disorders in patients with transplanted kidney. In a study by Sever and associates on the frequency of pericarditis in patients following kidney transplanta-

The development of pericarditis in patients with a transplanted kidney may contribute to the

Cardiovascular diseases are the main cause of morbidity and mortality in post-transplant patients [52]. The risk assessment of cardiovascular disease in asymptomatic patients with a transplanted kidney is of great practical importance because it allows the identification of patients at high risk for cardiovascular events, which further allows timely intervention before the disease develops. To assess the risk of cardiovascular disease in asymptomatic patients with a transplanted kidney, we can apply the scores used for assessment of cardiovascular risk in general population. The scores for the general population are the Systematic Coronary Risk

4. Assessment of the risk of cardiovascular disease in asymptomatic

3.4. Valvular heart disease, heart rhythm disorders, and pericardial disease

use of immunosuppressive therapy as it increases the risk of infection [51].

ondary hyperparathyroidism.

apy, statins and beta blockers.

tion, an incidence of 2.4% was observed [50].

patients with a transplanted kidney

five times higher than the general population [6].

324 Organ Donation and Transplantation - Current Status and Future Challenges

Evaluation SCORE system, the Prospective Cardiovascular Munster PROAM score system, and the National Cholesterol Education Program Adult Treatment Panel III NTEP ATP III [53].

The new risk assessment model is based on the Heart Score system (Systematic Coronary Risk Evaluation). The Heart Score Risk Card has been developed on the basis of large prospective studies in Europe and predicts the fatal outcomes of cardiovascular disease for 10 years. The assessment is based on the following risk factors: age, sex, smoking, systolic blood pressure, total cholesterol, or cholesterol/HDL ratio. A high risk threshold based on a fatal cardiovascular outcome is defined as more than or equal to 5%.

population. The incidence of congestive heart failure in patients with a transplanted kidney was 10.2% 12 months after transplantation and 18.3% 36 months after transplantation. The risk assessment of cardiovascular disease in asymptomatic patients with a transplanted kidney is of great practical importance because it allows the identification of patients at high risk for cardiovascular events, which further allows timely intervention before the disease develops. To assess the risk of cardiovascular disease in asymptomatic patients with a transplanted kidney, we can apply the scores used for assessment of cardiovascular risk in general population. Several studies have shown that the use of standard scores in the assessment of the degree of risk of cardiovascular disease in patients with renal disease is insufficient. It is recommended that standard risk factors be enhanced with additional risk factors (e.g., homocystein, Creactive protein). Additional risk factors are recommended for increasing the precision of risk assessment. Assessing the patient's risk of developing cardiovascular disease enables the identification of patients at high risk for the development of cardiovascular events, which

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allow the intervention before the disease develops.

\*Address all correspondence to: hodzic\_selma@live.com

Clinic for Internal Disease, University Clinical Center Tuzla, Bosnia and Herzegovina

alternative. Nephrology, Dialysis, Transplantation. 1998;13:1799-1803

ment of cardiovascular disease. Circulation. 2003;108:2154-2169

logical perspective. Kidney International. 2006;70(1):26-33

[1] Tabaković M. Transplantacija bubrega: Faktori rizika nakon transplantacije bubrega U: Suada Mulić-Bačić. Interna medicina, I izdanje. OFF-SET Tuzla: Tuzla; 2011. pp. 355-378

[2] Asderakis A, Augustine T, Dyer P. Pre-emptive kidney transplantation: The attractive

[3] Amend WJC, Vincenti F, Tomlanovich S. The first posttransplant months. In: Danovich GM, editor. Handbook of Kidney Transplantation. Ed Little, Brown and Comp; 1996 [4] Ležaić V, Stojković D. Rani period posle transplantacije bubrega U: Višnja Ležaić, Ljubica Đukanović. Transplantacija bubrega, I izdanje. Beograd: Zavod za udžbenike i nastavna

[5] Mark S, Andrew L, Anton CS, Josef C, et al. Kidney disease as a risk factor for develop-

[6] Radivojević D. Kardiovaskularne bolesti posle transplantacije bubrega U: Višnja Ležaić, Ljubica Đukanović. Transplantacija bubrega, I izdanje. Beograd: Zavod za udžbenike i

[7] Zoccali C. Tradicional and emerging cardiovascular and renal risk factors: An epidemio-

Author details

References

Daniela Loncar and Selma Hodzic\*

sredstva; 2004. pp. 177-192

nastavna sredstva; 2004. pp. 231-245

Early detection of high-risk patients for the development of cardiovascular diseases allows timely application of an appropriate therapeutic strategy that ensures high survival rates for patients with a transplanted kidney (Table 1).

Assessing the patient's risk of developing cardiovascular disease enables the identification of patients at high risk for the development of cardiovascular events, which allow the intervention before the disease develops. In asymptomatic patients, cardiovascular risk assessment should be carried out and preventive activates should be performed accordingly. Patients with established multifactorial risk should be subjected to preventive activities, and, if necessary to medication therapy.

Several studies have shown that the use of standard scores in the assessment of the degree of risk of cardiovascular disease in patients with renal disease is insufficient [54]. In these scores, we use the following data: age, gender, blood pressure, lipid level, without taking into account nontraditional risk factors for occurrence of cardiovascular diseases.

Nontraditional risk factors that are not included in these scores can play an important role in the insufficient assessment of the risk of cardiovascular disease in patients with a transplanted kidney. All these point should be consider by creating a new risk score that would include both traditional and nontraditional risk factors for cardiovascular disease. It is recommended that standard risk factors be enhanced with additional risk factors (e.g., homocystein, C-reactive protein). Additional risk factors are recommended for increasing the precision of risk assessment.
