Ethnicity is a contributing risk factor of cardiovascular problems in kidney recipients of South Asian origin post-transplant, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN).
South Asians comprise 25% of all Canadian visible minorities and have a higher risk for cardiovascular disease in the general population. However, the risk of cardiovascular events has never been studied in this minority population.
To investigate, G.V. Ramesh Prasad, MBBS, MSc, FRCPC, FACP, FASN (University of Toronto) and his colleagues studied 864 kidney recipients (139 South Asians, 550 Caucasians, 65 blacks, and 110 East Asians) transplanted from 1998-2007, following them through June 2009. The identified risk factors included ethnicity associated with major cardiac events (MACE, a composite of non-fatal myocardial infarction, coronary intervention, and cardiac death) within and beyond 3 months post-transplant. They found no difference among the patients pre-transplant. However, the post-transplant MACE event rate was more than twice as high in South Asians, as in Caucasians, blacks, and East Asians.
Take home message: "Heart disease is the number one killer in kidney transplant patients. Traditional risk factors (age, high blood pressure, diabetes, smoking, and high cholesterol) do not fully explain the increased risk. This study identifies another risk factor for heart disease in transplant patients and the need for further study," said Dr. Prasad.
This research indicates that South Asians require their own category in all U.S. transplant and dialysis registry studies, along with Caucasians, blacks, Hispanics, East Asians, and Native Americans.
Limitations: This was a single center study. Much of the data was collected retrospectively, and ethnicity was typically assigned by patient self-report.
Study co-authors include Sai Vangala, Michael Huang, Lindita Rapi, and Michelle Nash (St. Michael's Hospital, Renal Transplant Program); Samuel Silver and Steven Wong (University of Toronto, Medicine); and senior author Jeffrey Zaltzman (St. Michael's Hospital, Renal Transplant Program and University of Toronto, Medicine).
This study was previously reported as an oral presentation at the American Transplant Congress 2010 in San Diego, CA, USA.
Disclosures: The authors reported no financial disclosures. The study was funded in part by the Heart and Stroke Foundation of Ontario.
The article, entitled "South Asian Ethnicity as a Risk Factor for Major Adverse Cardiovascular Events after Renal Transplantation," will appear online at http://cjasn.asnjournals.org/ on September 30, 2010, doi 10.2215/CJN.03100410.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Founded in 1966, the American Society of Nephrology (ASN) is the world's largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.
Journal
Clinical Journal of the American Society of Nephrology