2.2. Risk factors related to the status of transplantation and its treatment

In patients who at the moment of transplantation have no signs of atherosclerosis, reduced graft function and immunosuppressive therapy may cause hypertension, dyslipidemia, diabetes mellitus, and proteinuria, which can lead to myocardial infarction, stroke, or peripheral vascular disease.

than the relative risk of 1.37 related to an increase in systolic pressure of 15 mmHg. Anemia

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Treatment of patients with transplanted kidney and post-transplant anemia should be started with erythropoietin, when the hemoglobin concentration is less than 110 g/l and the target

Homocysteine concentration is an independent risk factor for cardiovascular disease after kidney transplantation [32]. In patients with a transplanted kidney, the concentration of homocysteine decreases compared to patients treated with dialysis but is higher than the concentration of homocysteine in healthy population, so hyperhomocysteinemia is common in patients after kidney transplantation [33]. For the treatment of hyperchomocysteinemia, we use folate

There is clear evidence that elevated levels of fibrinogen, factor VII, and von Willebrand factor in the general population are associated with an increased risk of acute insult or coronary disease [34]. These factors have also been elevated in patients following kidney transplantation, in more patients with cardiovascular disorders than in patients who do not have them. Secondary hyperparathyroidism is a risk factor for the development of cardiovascular disease in patients with a transplanted kidney [35]. After transplantation of the kidney, hyperparathyroidism is maintained in 50% of patients, characterized by hypercalcaemia, hyperphosphatemia and increased parathormone concentration [36]. Secondary hyperparathyroidism in post-transplantation may also occur new, as a consequence of the decline in the function of the allograft and the lack of calcitriol. The disorder of metabolism of calcium and phosphate results in calcification of peripheral arteries, including coronary artery calcification. Cinacalcet may be useful in the treatment of persistent hyperparathyroidism after kidney transplant.

The effect of local inflammatory stimulus such as products of the oxidation process, the end products of glycosylation and chronic infectious processes alter the blood vessel in terms of the development of atherosclerosis. Microinflammation is a risk factor for the development of atherosclerotic cardiovascular diseases in patients with a transplanted kidney [24]. These patients have a low level of microinflammation as a consequence of a systemic immune response to the presence of all antigens but also because of chronic infections [25]. C-reactive protein >5 mg/l > 0.5 mg/dl) is associated with an increased risk of developing cardiovascular

Proteinuria occurs in one-third of post-transplant patients and is a risk factor for the develop-

Thanks to the progress in histocompatibility testing and better immunosuppressive therapy, graft survival has increased, so that the leading cause of graft loss after transplantation has been the death of a patient with functional graft. Cardiovascular disease is the leading cause of

events in the population of patients with a transplanted kidney.

ment of cardiovascular disease in patients with a transplanted kidney [37].

3. Cardiovascular disease in patients with transplanted kidney

together with hypertension leads to left ventricular hypertrophy.

hemoglobin level should be 110–120 g/l.

and Vitamin B (12).

Allograft function disorder is a risk factor for the development of cardiovascular disease [24]. A year after renal transplantation, chronic allograft disease at stage 3 (glomerular filtration <60 ml/min/1.73 m2 ) has 60%, and in stage 4 (glomerular filtration value <30 ml/min/1.73 m<sup>2</sup> ) has 15% of patients [25]. With the decline in the allograft function, nontraditional risk factors appear. They occur when the glomerular filtration value falls below 60 ml/min/1.73 m2 , and especially when it is below 45 ml/min/1.73 m2 .

Reduced function of transplanted kidney in transplant recipient is an independent and important risk factor for the development of cardiovascular diseases due to adverse effects on hypertension, anemia, dyslipidemia, hyperhomocysteinemia [26]. The American National Kidney Foundation (NKF) reported that the value of glomerular filtration (GFR) measured or estimated is a better parameter of renal function than serum creatinine only [27]. The prevalence of left ventricular hypertension is inversely proportional to the level of glomerular filtration. In one study, the frequency of left ventricular hypertension was 45, 31 and 27% in patients with creatinine clearance <25, 25–50, and >50 ml/min [28].
