Analysis Of Trends In Coronary Artery Calcification And Its Correlative Factors In Renal Transplant Recipients

Objective:To investigate the factors correlated to coronary artery calcification(CAC) and analyze the trends in CAC in renal transplant recipients.Methods.-The CAC score was evaluated by multislice spiral computed tomography (MSCT) in 46 renal transplant recipients who divided into two groups (with CAC group and without CAC group). Other clinical datas of these patients were obtained simultaneously, included blood pressure, pretransplantation dialysis duration, transplantation duration, calcium, creatinine, low density lipoprotein(LDL), serum fetuin A, high-sensitivity C-reactive protein (HsCRP), et al. Data between patients with and without CAC were compared by using unpaired t-test. To identify independent factors for CAC, multivariable logistic regression analysis was performed. And a repeat evaluation 12 months later. Continuous data between baseline and 12 months were compared by means of Wilcoxon sign-rank test for nonparametric paired data or paired t-test.Results:The study showed that patients with CAC(15persons,32.61%) had significantly higher age, pretransplantation dialysis duration, serum calcium level, LDL, HsCRP, albumin, and lower serum fetuinA level than patients without CAC (31persons,67.39%) (P<0.05). The level of serum fetuinA was (0.27±0.04) g/L in patients with CAC, significantly lower than that in patients without CAC [(0.34±0.07) g/L, P<0.05]. Multivariable Logistic regression analysis showed that serum LDL and Age were independent factors of CAC(P<0.05). Serum fetuin A, age, pretransplantation dialysis duration, LDL, HsCRP in these 46 patients were related with CAC score(r and P values were r=-0.48 P 0.05; r=0.51 P<0.05; r=0.35 P<0.05and r=0.66 P <0.05, respectively).And age, HsCRP were related with serum fetuin A(r=-0.30 P<0.05 and r=-0.57 P<0.05, respectively). There was no correlation of fetuin A with some laboratory examinations, included cholesterol level, high-density lipoprotein(HDL), LDL, calcium level, phosphate level, calciumxphosphate product, Parathyroid hormone, et al.39 Patients were evaluated again 12 months later. The level of HsCRP and serum triglyceride(TG) was significantly higher than at baseline (P<0.05). The level of serum HDL was significantly lower than at baseline (P<0.05). Mean (SD) CAC score increased for all subjects from 21.59 (54.64) at time of 12 months ago to 37.15 (71.43) (P<0.05). There is significant progression of CAC after renal transplantation in most subjects. Mean annualized rate (SD) of CAC score change was 15.56(46.42). Mostsubjects (80.00%) remained without calcification in without CAC group.Conclusions:Serum fetuin A, age, pretransplantation dialysis duration, LDL, HsCRP are related with CAC score.Age and LDL are important factors to CAC. The trend in CAC is progressive in renal transplant recipients. The development of CAC is influenced mainly by the level of serum TG and HDL. Improving lipide, shortening pretransplantation dialysis duration, controling infection may reduce the risk of vascular calcification in renal transplant recipients. May be synthesize endogenous inhibitor of fetuin A help to offer a new method to vascular calcification.