Central aortic pressure augmentation in stable renal transplant recipients

effect of arterial wave reflections on central arteries has recently been shown to be an important independent predictor of base available for the rational management of cardiovascardiovascular mortality in chronic hemodialysis patients. The cular risk in renal transplant recipients is small. aim of this study was to assess the contribution of several Enhanced augmentation of the central aortic systolic classical and potential non-classical cardiovascular risk factors pressure by the increased effect of arterial wave reflecon aortic pressure augmentation by the reflected arterial wave tions, as defined by the augmentation index (AIx), has in stable renal transplant recipients. recently been shown to be a powerful predictor of cardioMethods. Using the non-invasive technique of pulse wave analysis aortic augmentation was investigated in 250 stable vascular and all cause mortality in patients on chronic renal transplant recipients. Peripheral pulse waveforms were hemodialysis (Fig. 1) [2]. The technique of central pulse recorded from the radial artery. Central aortic waveforms were wave analysis employs applanation tonometry to record then generated and the aortic augmentation index calculated. the pressure wave from the radial artery accurately [3], Results. In multivariate analysis, female sex (regression coef- and a well-validated generalized transfer factor can then ficient 7.5 1.7%; P 0.001), heart rate (4.8 0.5% per 10 beats/min; P 0.001), mean arterial pressure (4.2 0.6% be used to generate the corresponding aortic arterial per 10 mm Hg; P 0.001), the persistence of an arteriovenous waveform [4]. From this, AIx can be assessed non-invafistula (4.1 1.3%; P 0.005), total time on renal replacement sively and reproducibly [5, 6]. therapy (3.8 0.9% per 10 years; P 0.001), height (3.1 Classical risk factors do not account for the totality 0.8% per 10 cm; P 0.001), immunosuppression with cyclo- of cardiovascular risk in renal transplant recipients. A sporine (2.8 1.3%; P 0.005) and age (2.5 0.5% per recent study found that the Framingham Heart Study10 years; P 0.001) were all important correlates of aortic augmentation index. based cardiovascular risk equation significantly underConclusions. Our findings suggest, to our knowledge for the estimated the risk of ischemic heart disease in renal transfirst time, that both the presence of a functioning arteriovenous plant recipients [7]. These findings suggest that other fistula and immunosuppressive treatment with cyclosporine are factors, in particular non-classical cardiovascular risk associated with an increased aortic augmentation index in re- factors, may play a significant role in the increased carnal transplant recipients and could, therefore, be potential rediovascular risk observed in these patients. Identification versible contributors to the high cardiovascular risk profile in these patients. of these non-classical risk factors might help target interventions to reduce the high incidence of cardiovascular events observed in renal transplant recipients. The aim of this study was to assess the impact of several classical Premature cardiovascular disease is the leading cause