Introduction and objective: The profile of kidney transplantation (KT) candidates is changing, with a growing burden of comorbidities that lead to a distinct pattern of cardiovascular complications (CVC). Our objective is to describe the CVCs occurring within one year after KT and to assess whether the current approach to pre-transplant cardiovascular evaluation should be reconsidered, with a stronger focus on preventing the most frequent events.
Materials and methods: This is an observational, analytical, and retrospective study of patients who underwent KT in our autonomous community between January 2020 and December 2022. Advanced cardiological studies were performed in patients with multiple cardiovascular risk factors, diabetes mellitus, angina-like symptoms or a history of coronary artery disease. CVCs were defined as the occurrence of acute coronary syndrome (ACS), heart failure (HF), stroke, peripheral vascular disease (PVD) or cardiovascular (CV) death. Usual treatment for each patient was recorded based on the admission report.
Results: A total of 156 patients received KT, of whom 73% were male with a mean age of 57 years. Table 1 shows the population profile and the cardiological studies performed prior to the procedure. Table 2 describes the patients usual pharmacological treatment. During the first year, 8 patients (5.1%) were hospitalised with ACS, 19 (12.1%) with HF, 3 (1.9%) with stroke and 5 (3.2%) with PVD. There were 7 deaths (4.5%) one of which was attributed to CV causes. Analysing the risk factors for developing HF, 12% of patients presented atrial fibrillation, 23% a body mass index over 30 and 55% of diabetic patients out-of-range glycated haemoglobin levels. However, no patient was receiving treatment with sodium-glucose co- transporter 2 inhibitors (SGLT2i), and only 1% was treated with GLP-1 receptor agonists.
Conclusion: The most frequent CVC after KT is HF, which doubles the ACS incidence. The current cardiological assessment and the pharmacological management prior to KT probably need to be reconsidered, with greater emphasis on HF prevention strategies.
