Towards personalized cardiovascular risk management in renal transplant recipients
Towards personalized cardiovascular risk management in renal transplant recipients
Cardiovascular disease are the primary cause of death in renal transplant recipients (RTR). In line, cardiovascular risk is greatly increased in RTR compared to the general population. This is due to an interaction of traditional cardiovascular risk factors, which are also present in the general population (such as high blood pressure, obesity and diabetes) and transplantation-related risk factors (such as decreased kidney function and use of immunosuppressive drugs such as prednisolone). In this thesis, we aimed to find new strategies to reduce cardiovascular risk in RTR and to personalize treatment. High blood pressure is the most prevalent cardiovascular risk factor in RTR. We found (using a randomized cross-over trial) that dietary sodium restriction impressively reduces blood pressure in RTR, without affecting kidney function. In addition, we studied treatment with prednisolone. Chronic prednisolone treatment has several unwanted side effects (such as high blood pressure, diabetes and osteoporosis). Prednisolon is structurally similar to the endogenous stress-hormone cortisol, and is therefore able to interfere in cortisol production and metabolism. We found that the degree of cortisol synthesis and metabolism in prednisolone-treated RTR is associated with the severity of prednisolone side effects, prevalence of the metabolic syndrome and also with long-term risk of cardiovascular mortality. Therefore non-pharmacological treatment with dietary sodium restriction and monitoring prednisolone therapy (by means of measuring cortisol homeostasis) could be ways to reduce increased cardiovascular risk in RTR in the future.