TY - JOUR
T1 - Major adverse cardiovascular events and hyperuricemia as an effect-modifying factor in kidney transplant recipients
AU - Junk, Elizabete
AU - Tzivian, Lilian
AU - Folkmane, Inese
AU - Folkmanis, Kristofs
AU - Jushinskis, Janis
AU - Strazda, Gunta
AU - Folkmanis, Valdis
AU - Kuzema, Viktorija
AU - Petersons, Aivars
N1 - Publisher Copyright:
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
PY - 2025/9/18
Y1 - 2025/9/18
N2 - BACKGROUND Major adverse cardiovascular (CV) events (MACEs) are the primary cause of morbidity and mortality in kidney transplantation (KT) recipients. The risk for MACEs is impacted by an array of traditional and transplant-related non-traditional CV risk factors. AIM To investigate the association between potential CV risk factors related to KT and MACEs, and their potential modification by hyperuricemia (HU). METHODS The relationship between CV risk factors related to KT and MACEs was examined in a cohort of 545 patients who underwent transplantation between 2008 and 2019. The mean age of patients at KT was 55.0 years ± 14.2 years (range 15.0–89.0 years). Univariate and multivariate logistic regression models were constructed to identify risk factors influencing MACEs. To explore the potential effect modification by uric acid (UA), patients were categorized into groups based on UA levels: (1) Low (< 356 μmol/L); (2) Normal (356–416 μmol/L); (3) High (416–475 μmol/L); and (4) Very high (> 475 μmol/L). RESULTS MACEs occurred in 145 of 545 (26.6%) KT recipients. The most prevalent comorbidities were hypertension (87%), dyslipidemia (78%), secondary hyperparathyroidism (68%), HU (63%) and anemia (33%). In the multivariate logistic regression model, the most significant factors associated with MACEs were previous CV events [odds ratio (OR) = 70.6, 95%CI: 24.9–200.1], left ventricular hypertrophy (LVH) (OR = 12.6, 95%CI: 2.7– 58.3), HU treatment (OR = 4.3, 95%CI: 2.4–7.6), and anemia (OR = 5.3, 95%CI: 2.9–9.8). Effect modification by the presence of HU revealed that independent factors associated with MACEs were age (OR = 1.03, 95%CI: 1.0–1.1), previous CV events (OR = 41.7, 95%CI: 13.6–127.6), LVH (OR = 15.3, 95%CI: 2.0–116.6), HU treatment (OR = 2.5, 95%CI: 1.3–4.6) and anemia (OR = 5.4, 95%CI: 2.8–10.5). Effect modification by UA levels dichotomized at 475 μmol/L (very high level of UA) revealed that HU treatment was not associated with MACEs in groups with or without very high UA levels. CONCLUSION A very high level of UA was observed to act as an effect-modifying factor for MACEs, especially when combined with other risk factors such as age, previous CV events, LVH, and anemia.
AB - BACKGROUND Major adverse cardiovascular (CV) events (MACEs) are the primary cause of morbidity and mortality in kidney transplantation (KT) recipients. The risk for MACEs is impacted by an array of traditional and transplant-related non-traditional CV risk factors. AIM To investigate the association between potential CV risk factors related to KT and MACEs, and their potential modification by hyperuricemia (HU). METHODS The relationship between CV risk factors related to KT and MACEs was examined in a cohort of 545 patients who underwent transplantation between 2008 and 2019. The mean age of patients at KT was 55.0 years ± 14.2 years (range 15.0–89.0 years). Univariate and multivariate logistic regression models were constructed to identify risk factors influencing MACEs. To explore the potential effect modification by uric acid (UA), patients were categorized into groups based on UA levels: (1) Low (< 356 μmol/L); (2) Normal (356–416 μmol/L); (3) High (416–475 μmol/L); and (4) Very high (> 475 μmol/L). RESULTS MACEs occurred in 145 of 545 (26.6%) KT recipients. The most prevalent comorbidities were hypertension (87%), dyslipidemia (78%), secondary hyperparathyroidism (68%), HU (63%) and anemia (33%). In the multivariate logistic regression model, the most significant factors associated with MACEs were previous CV events [odds ratio (OR) = 70.6, 95%CI: 24.9–200.1], left ventricular hypertrophy (LVH) (OR = 12.6, 95%CI: 2.7– 58.3), HU treatment (OR = 4.3, 95%CI: 2.4–7.6), and anemia (OR = 5.3, 95%CI: 2.9–9.8). Effect modification by the presence of HU revealed that independent factors associated with MACEs were age (OR = 1.03, 95%CI: 1.0–1.1), previous CV events (OR = 41.7, 95%CI: 13.6–127.6), LVH (OR = 15.3, 95%CI: 2.0–116.6), HU treatment (OR = 2.5, 95%CI: 1.3–4.6) and anemia (OR = 5.4, 95%CI: 2.8–10.5). Effect modification by UA levels dichotomized at 475 μmol/L (very high level of UA) revealed that HU treatment was not associated with MACEs in groups with or without very high UA levels. CONCLUSION A very high level of UA was observed to act as an effect-modifying factor for MACEs, especially when combined with other risk factors such as age, previous CV events, LVH, and anemia.
KW - Cardiovascular risk
KW - Effect modification by hyperuricemia
KW - Hyperuricemia
KW - Hyperuricemia treatment
KW - Kidney transplantation
KW - Major adverse cardiovascular events
KW - Uric acid
UR - http://www.scopus.com/inward/record.url?scp=105003138228&partnerID=8YFLogxK
U2 - 10.5500/wjt.v15.i3.102287
DO - 10.5500/wjt.v15.i3.102287
M3 - Article
AN - SCOPUS:105003138228
SN - 2220-3230
VL - 15
JO - World Journal of Transplantation
JF - World Journal of Transplantation
IS - 3
M1 - 102287
ER -