ArticlePerioperative medicine (London, England)2025
Refining cardiovascular risk prediction after renal transplantation: a cross-sectional study focusing on NT-proBNP and the revised cardiac risk index.
Article in Perioperative medicine (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCardiovascular complications significantly influence outcomes in kidney transplant recipients, predominantly driven by the multifactorial risks associated with end-stage renal disease (ESRD). This study investigates the utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the revised cardiac risk index (RCRI) in predicting cardiovascular events (CVE) after kidney transplantation (KT), aiming to refine risk assessment and management strategies pre-transplantation.
methodsFrom May 2021 to May 2023, 122 ESRD patients scheduled for kidney transplantation were enrolled in a prospective cohort study at a single center. Pre-transplant NT-proBNP levels and RCRI scores were evaluated for their predictive accuracy for in-hospital and 1-month post-transplant CVEs.
resultsThe median age of participants was 47.7 years. Pre-existing hypertension was present in 80.3%, diabetes in 26.2%, smoking history in 9.0%, and cardiovascular disease in 23%. A revised cardiac risk index (RCRI) score of 1 was present in 64.8% of cases. Over half of the patients had NT-proBNP levels above 1200 pg/mL. Patients with higher NT-proBNP levels exhibited lower left ventricular ejection fraction (LVEF) and higher systolic pulmonary artery pressure (PAP). Patients who experienced at least one CVE were older, with a trend toward a higher NT-proBNP level in this population. The RCRI showed no significant difference between patients with NT-proBNP levels above or below 1200 pg/mL. Still, it differed among patients with at least one CVE compared to those without. After adjusting the NT-proBNP level, RCRI = 3 had an odds ratio of 9.6 (1.6-57.4) for cardiovascular endpoints compared to those with RCRI 1 and 2.
conclusionNT-proBNP alone could not predict 30-day CVE after KT. Regarding the trend toward higher NT-proBNP levels in individuals with at least one CVE, further studies with a larger sample size should be done to assess whether integrating NT-proBNP and RCRI before KT can improve cardiovascular outcomes in this high-risk population.
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