Acute Kidney Injury and Long-Term Risk for Cardiovascular Events in Patients after Kidney Transplantation

Ruth Rahamimov*, Tuvia Y. Van Dijk, Maya Molcho, Itay Vahav, Eytan Mor, Naomy Ben Dor, Shira Goldman, Benaya Rozen-Zvi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Acute kidney injury (AKI) was found to be associated with an increased risk of major adverse cardiovascular events (MACE) in the general population. Patients after kidney transplantation are prone to AKI events and are also at an increased risk of cardiovascular (CV) disease. The association between AKI and MACE in kidney transplant patients is yet to be studied. Methods: This retrospective single-center cohort study reviewed 416 adult renal allograft recipients transplanted between 2005 and 2010. AKI events were recorded starting 2 weeks after transplantation, or following discharge with a functioning graft. AKI was defined, according to the KDIGO criteria. The primary outcome was the composite of MACE starting 6 months after transplantation and all-cause mortality. For survival analysis, we used univariate and multivariate time varying Cox proportional hazard model. Results: One hundred and twenty-four patients (29.8%) had at least one episode of AKI. During the median follow-up time of 7.2 years (interquartile range 4.3-9.1), 144 outcome events occurred. By time varying Cox regression analysis, AKI was associated with an increased rate of CV outcomes or death (hazard ratio [HR] 1.96, 95% CI 1.36-2.81, p < 0.001), and the association remained significant by multivariate adjusted model (HR 1.76, 95% CI 1.18-2.63, p = 0.005). As for the different components of MACE, all-cause mortality and CV mortality were the only outcomes that were significantly associated with AKI. No interaction between AKI timing and MACE was found. Conclusion: AKI in kidney transplant recipient is associated with an increased risk of CV disease.

Original languageEnglish
Pages (from-to)1149-1157
Number of pages9
JournalKidney and Blood Pressure Research
Issue number5
StatePublished - 1 Oct 2019


  • Acute kidney injury
  • Kidney transplantation
  • Major adverse cardiovascular events


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