Etiology of Cardiac Disease in Kidney Transplant Recipients

Cardiovascular disease is a major cause of morbidity and mortality after kidney transplantation. Effective prevention and management of cardiovascular disease in kidney transplant recipients are integral to increasing patient longevity and quality of life, in addition to improving graft survival. This article discusses cardiovascular disease and its management in kidney transplant recipients. The high prevalence of cardiovascular complications in kidney transplant recipients is explained by cardiovascular risk factors present before transplantation, in addition to the development of new risk factors and worsening of preexisting risk factors after transplantation. Traditional independent risk factors for atherosclerotic cardiovascular disease include cigarette smoking, hypertension, dyslipidemia, male gender, diabetes mellitus, and advancing age. Kidney disease and kidney transplantation introduce additional cardiovascular risks that typically do not operate in the general population. For example, specific immunosuppressive drugs, graft dysfunction, and graft failure increase cardiovascular risk in the kidney transplant recipient. The management of cardiovascular risk in the kidney transplant recipient entails promotion of therapeutic lifestyle practices (eg, healthy diet, exercise, and avoidance of smoking), use of evidence-based pharmacotherapy, and strategies for optimizing provider and patient compliance. These strategies should be implemented before transplantation and should continue throughout the post-transplant course. (Adv Stud Med. 2007;7(6):169-178) INTRODUCTION