Article A Longitudinal Study of Inflammation, CKD-Mineral Bone Disorder, and Carotid Atherosclerosis after Renal

Background and objectives The role of reversibility of nontraditional risk factors, like inflammation and CKD-mineral bone disorder, in the reduction of cardiovascular risk after renal transplantation is still scarcely defined. Design, setting, participants, and measurements The longitudinal relationship between C-reactive protein, CKD-mineral bone disorder biomarkers, and intima media thickness was investigated in a series of 178 patients (age=32610 years) with stage 5 CKDmaintained on chronic dialysis who underwent echo-color Doppler studies of the carotid arteries before and after renal transplantation. Smokers and patients with diabetes were excluded from the study. In all patients, immunosuppression was performed by a standard regimen on the basis of calcineurin inhibitors. Healthy controls were specifically selected to match the age and sex distribution of the patients. Biochemical and intima media thickness assessments were repeated 6 months after transplantation. ResultsBefore transplantation, intimamedia thickness inpatientswith stage 5CKDondialysis (average=0.960.2mm) was higher (P,0.001) than in well matched healthy controls (0.660.1 mm) and reduced substantially (222%; 95 % confidence interval, 224 % to 220%) after transplantation (P=0.001). GFR (multivariable-adjusted b=0.23; P,0.001), C-reactive protein (b=0.15; P,0.001), and fibroblast growth factor 23 (b=0.28; P,0.001) were the strongest independent correlates of intima media thickness before transplantation. Similarly, longitudina