Evidence of enhanced systemic inflammation in stable kidney transplant recipients with low Framingham risk scores

Abstract

Background: While the Framingham risk score (FRS) predicts cardiovascular risk in the general population, it underestimates cardiovascular events in renal transplant recipients (RTR). Inflammation is common in RTR, and it is also a hallmark of vascular injury contributing to cardiovascular events.

Objective: To explore the relationship between inflammatory chemokines (CCL family) and FRS in a stable RTR.

Methods: The modified FRS (2009) was used to calculate the 10-yr probability of CVE in 150 RTR. A cross-sectional study measured plasma levels of 14 CCLs by Luminex technique in 53% (79/150) of the cohort and 28 controls.

Results: 43.3% of RTR was classified as low, 16% moderate, and 40.7% high FRS. FRS correlated with eGFR and all CCLs with R of <0.2(p = n.s). Compared with controls, CCL 1,4,8,15, and 27 were equally increased in both the high and low FRS groups (p < 0.04 and 0.03, respectively). The percentage of patients with low FRS and CCL 8,15, and 27 values above the 95% cutoff control levels was 46.1%, 76.9%, and 53.8%, respectively.

Conclusions: Over one half of stable RTR, including those with low FRS, have increased inflammatory chemokine levels. Inflammation is not accounted for in the FRS, and this may explain the poor performance of FRS in transplant patients.

Keywords: Framingham; cardiovascular risk; chemokine; inflammation; kidney transplant.