Cardiovascular Risk In Adult Kidney Transplant Patients

More than 140,000 patients are living with a functioning kidney transplant in the United States. Although kidney transplantation confers relatively longer survival com- pared with any of the dialysis modalities, the life expectancy of kidney transplant recip- ients (KTRs) remains lower than that of the age- and sex-matched general population. 1 Cardiovascular (CV) disease is the single leading cause of death in KTRs and the major- ity of functioning transplants are lost due to the recipient's death. Thus, primary pre- vention, early detection, and secondary prevention of CV disease in KTRs could be instrumental in further improving the outcomes of these patients. This issue of Nephrology Rounds reviews the evidence on individual CV risk factors and potential treatment interventions in KTRs. While determinants of CV risk in the general population have been studied for several decades, predominantly with the use of large prospective studies such as the Framingham Study cohort, the importance of impaired kidney function as a CV risk factor has only recently been recognized. 2 Further, the best prevention and treatment for the CV epidemic in patients with advanced kidney disease remains unclear. The evidence supporting standards of CV pre- vention and care in the general population has been derived from randomized controlled trials that systematically excluded patients with advanced chronic kidney disease (CKD), including KTRs. While some physicians have proposed that KTRs are similar to patients with CKD, there are at least 3 important reasons why this may not be the case: the presence of immuno- suppressant therapy, the altered inflammatory milieu, and the past history of prolonged main- tenance dialysis therapy in most KTRs.