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Aortic pulse wave velocity in renal transplant patients.

BACKGROUND
In subjects with end-stage renal disease (ESRD) undergoing hemodialysis, aortic pulse wave velocity (PWV) is increased independently of blood pressure level and mostly is a strong predictor of cardiovascular risk. Few studies on this subject have been performed in renal transplant patients.


METHODS
Aortic PWV was determined noninvasively in 106 patients with kidney transplantation and treated using a standard immunosuppression protocol. Mean age was 43 +/- 14 years. During the follow-up period (mean duration 54.3 +/- 28.9 months), the following parameters were studied: characteristics of the renal graft, degree of renal insufficiency, number of acute rejections, cardiovascular risk factors, drug medications, and cardiovascular complications.


RESULTS
Aortic PWV was increased in subjects with renal transplants independently of age and mean blood pressure. Acute renal rejection and smoking habits were the principal factors modulating together: the increase of aortic PWV and the reduction of the glomerular filtration rate (GFR). The latter renal parameter was also influenced by the donor age. Two main parameters were predictors of cardiovascular events: a past history of cardiovascular disease and the pulse pressure x heart rate product, the major mechanical consequence of increased PWV.


CONCLUSION
In renal transplant subjects, tobacco consumption and mostly acute renal rejection modulate both aortic stiffness and chronic renal failure independent of blood pressure level and donor characteristics. Pulsatile stress mediates cardiovascular complications and predicts cardiovascular risk, particularly in the presence of increased heart rate.