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Effects of metabolic syndrome on kidney transplantation outcomes: a systematic review and meta-analysis.
Pedrollo, EF, Corrêa, C, Nicoletto, BB, Manfro, RC, Leitão, CB, Souza, GC, Gonçalves, LF
Transplant international : official journal of the European Society for Organ Transplantation. 2016;(10):1059-66
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Abstract
Metabolic syndrome (MS) has been associated with proteinuria and reduced glomerular filtration rate. Immunosuppressive agents increase the incidence of traditional risk factors for cardiovascular disease (CVD) and have known effects on MS components after kidney transplantation. The purpose of this meta-analysis was to evaluate the impact of MS on relevant outcomes after kidney transplantation. MEDLINE, EMBASE, and Cochrane Library were searched up to November 7, 2015. Papers that compared patients with and without MS and assessed one of the following outcomes, graft loss, death by cardiovascular disease, and all-cause mortality, were included. Of 585 studies identified, five studies including 1269 patients were evaluated. MS was identified as a risk factor for graft loss [relative risk, 3.06; 95% confidence interval (CI), 2.17, 4.32; I² = 0%; P heterogeneity = 0.72] and death by CVD (relative risk, 3.53; 95% CI, 1.27, 9.85; I² = 0%; P heterogeneity = 0.40). Results on the association between MS and all-cause mortality were inconclusive (relative risk, 2.61; 95% CI, 0.70, 9.81; I² = 58%; P heterogeneity = 0.09). Graft loss and death by CVD were associated with the presence of MS after transplantation. Randomized clinical trials should be conducted to define whether interventions on each MS component would result in better outcomes after transplantation.
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Adiposity and cardiovascular disease risk factors in renal transplant recipients: Are there differences between sexes?
Fernandes, JF, Leal, PM, Rioja, S, Bregman, R, Sanjuliani, AF, Barreto Silva, MI, Torres, MR
Nutrition (Burbank, Los Angeles County, Calif.). 2013;(10):1231-6
Abstract
OBJECTIVE The aim of this study was to evaluate high body adiposity and cardiovascular disease (CVD) risk factors prevalence, in renal transplant recipients (RTR), comparing men with women. METHODS In this retrospective cross-sectional study, 102 patients (55 men) who were 49 ± 1.2 y and 114.3 ± 9 mo post-transplant (post-tx) were evaluated. Pretransplant (pre-tx) period data and weight gain during the first year post-tx were obtained from patient charts and post-tx data were collected during a routine visit at nephrology clinic. Body mass index (BMI) ≥ 25 kg/m(2) defined overweight and BMI ≥ 30 kg/m(2) defined obesity. RESULTS Pre-tx overweight prevalence was low and similar between men and women (26%), whereas only women showed obesity (11%). Post-tx body weight increased significantly in the entire group, leading to an increase in overweight (to 38% in men and 51% in women) and obesity (to 11% in men and 23% in women) prevalence. Post-tx comparisons between men and women showed that women had higher (women versus men; P < 0.05) BMI values (26.7 ± 0.8 versus 24.7 ± 0.5 kg/m(2)), weight gain during first year post-tx (9.2 ± 1.1 versus 5.5 ± 1 kg), abdominal obesity (57% versus 23%) and diabetes (34% versus 16%) prevalence. The associations between adiposity and CVD risk factors showed that pre-tx overweight increased the risk for diabetes in post-tx; pos-tx high BMI and abdominal obesity increased the risk for metabolic syndrome; abdominal obesity increased the risk for dyslipidemia in women. CONCLUSIONS High body adiposity prevalence was high after transplantation and increased the risk for metabolic syndrome, an important CVD risk factor. Women showed higher total body adiposity values, abdominal obesity, and diabetes prevalence than men. Abdominal obesity increased the risk for dyslipidemia in women.
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Graft loss risk in renal transplant recipients with metabolic syndrome: subgroup analyses of the ALERT trial.
Soveri, I, Abedini, S, Holdaas, H, Jardine, A, Eriksson, N, Fellström, B
Journal of nephrology. 2012;(2):245-54
Abstract
BACKGROUND Several nonimmunologic risk factors for late renal graft loss (RGL) are also known components of metabolic syndrome (MS). We aimed to study MS as a risk factor for RGL. Also, the effect of statin treatment in reducing renal risk in renal transplant recipients (RTRs) with MS was studied. METHODS Nondiabetic RTRs (n=1,706) from the ALERT trial were followed for 7-8 years. MS was defined according to National Cholesterol Education Program Adult Treatment Panel III definition with waist girth replaced by BMI ≥30 (calculated as kg/m(2)). Renal end points included death-censored RGL and graft loss or doubling of serum creatinine. RESULTS During the follow-up, 284 patients experienced RGL, and there were 343 cases of graft loss or doubling of serum creatinine. Those with MS had increased risk for RGL (relative risk = 1.28, 95% confidence interval, 1.00-1.63; p=0.047), but not for the combined end point. After adjustment for other known and potential risk factors, MS was no longer associated with increased risk for RGL. The association between MS and RGL risk was attenuated once adjustment for creatinine was made. Statin treatment did not reduce the risk for renal end points in RTRs with or without MS. CONCLUSION MS had no independent association with RGL risk. Adjustment for renal function attenuated the association between MS and RGL.
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Risk factors for metabolic syndrome in stable Italian renal transplant patients.
Fabbian, F, Bergami, M, Molino, C, De Giorgi, A, Pala, M, Longhini, C, Portaluppi, F
Clinical and experimental nephrology. 2011;(4):560-6
Abstract
BACKGROUND The prevalence of metabolic syndrome (MS) in renal transplant recipients (RTR) is still under investigation. METHODS We performed a cross-sectional study of 107 stable RTR who were diagnosed as having MS defined by the Adult Treatment Panel III of the National Cholesterol Education Program (NCEP-ATP III) criteria. Anthropometric, clinical and biochemical data were collected. RESULTS Mean age of the patients studied was 55 ± 11 years (72 male, 35 female), dialysis duration before transplantation 30 ± 31 months, time since transplantation 42 ± 13 months. Mean serum creatinine was 1.68 ± 0.64 mg/dl; creatinine clearance by Cockcroft-Gault formula 53 ± 20 ml/min, glomerular filtration rate by 4-variable MDRD formula 48 ± 18 ml/min/1.73 m(2). Thirty-seven patients (34.5%) had MS. The MS patients had higher weight (76 ± 13 vs. 68 ± 12 kg, p = 0.0033), body mass index (BMI) (26 ± 4 vs. 24 ± 3 kg/m(2), p = 0.0025), waist circumference (101 ± 11 vs. 90 ± 11 cm, p < 0.0001), prevalence of BMI >25 k/m(2) (57 vs. 34%, p = 0.0254), prevalence of diabetes mellitus before transplantation (8 vs. 0%, p = 0.0157), glycaemia (104 ± 31 vs. 87 ± 11 mg/dl, p = 0.0002), and triglyceridaemia (225 ± 105 vs. 112 ± 35 mg/dl, p < 0.0001). They also showed lower levels of high-density lipoprotein cholesterol (48 ± 15 vs. 68 ± 17 mg/dl, p < 0.0001). Multiple logistic regression analysis showed that only BMI was independently associated with MS (OR 1.21, 95% CI 1.06-1.37, p = 0.0037). CONCLUSIONS MS according to NCEP-ATP III criteria appears to be present in about one-third of RTR, and even small increases in BMI above 25 kg/m(2) may determine the presence of MS in these patients. Therefore the preventive value of lifestyle modifications is very important for such patients, in order to strictly maintain body fat accumulation within the normal range.