Evaluation of Cardiovascular Disease and Kidney Transplant by Dr Marie Chantel Fortin By Jim Myers

 Evaluation of Cardiovascular Disease and Kidney Transplant by Dr Marie Chantel Fortin 

 By Jim Myers

 1. Introduction

 I have been asked to review a study entitled, "Evaluation of Cardiovascular Disease and Kidney Transplant" by Dr Marie Chantel Fortin for the GET ON TRACK Study Group. This is a very interesting article concerning the effects of Cardiovascular Disease on Kidney Transplant Patients. Shockingly, cardiovascular disease is a leading cause of death in kidney transplant patients, even when the transplanted kidney is functioning well. 

 2. Did You Know: Cardiovascular Disease and Kidney Transplant 

 The author outlines 3 causes of cardiovascular diseases for us the affect kidney patients including:

• Coronary heart disease

 • Cerebrovascular brain disease & 

• Peripheral vascular disease. 

Others have suggested contributing causes like:

 • Diabetes 

• Congestive heart failure 

• Infection

 • Hypertension 

• Hyperlipidemia (genetic disorders resulting in a high level of lipids circulating in the blood)

 • Anemia 

• Unintended Affects of Immunosuppression. https://cjasn.asnjournals.org/content/3/2/491 The author notes that cardiovascular disease is responsible for one third of admissions to the hospital after kidney transplant and CVS can damage the transplanted kidney.

 Major risk factors include: 

• HBP 

• Diabetes

 • High Cholesterol Level 

• Smoking

 • Inactive Lifestyles.

 Other authorities seem to agree: https://academic.oup.com/ndt/article/34/5/760/5449079; https://pubmed.ncbi.nlm.nih.gov/29753404/; https://pubmed.ncbi.nlm.nih.gov/29753404/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482292/

 Other factors noted were:

 • Patent arteriovenous fistula 

• Traditional risk factors 

• Pre-Transplant cardiovascular disease

 • Chronic kidney disease

 • Albuminuria

 • Hyperhomocysteinemia 

• Homoarginine deficiency

 • Hyperphosphatemia 

• Dialysis vintage

 https://www.uptodate.com/contents/kidney-transplantation-in-adults-risk-factors-for-cardiovascular-disease-in-the-kidney-transplant-recipient 

 3. Research Shows: Issue for Discussion in the Paper- Cardiovascular Disease and Frequently Related Risk Factors After Kidney Transplantation

 The article does a great job of setting up the issues for discussion in the remainder of the piece demonstrating the connection between cardiovascular disease and the risk factors present after kidney transplant by statistics:

 "• High blood pressure, which is defined as a blood pressure over 140/90, affects 40-90% of all kidney transplant recipients.

 • Diabetes after transplantation affects between 24-42% of all kidney transplant recipients. Diabetes is defined as a fasting blood sugar over 7 mmol/L or a random glucose level (sugar level) higher than 11.1 mmol/L. 

 • High blood cholesterol, or dyslipidemia, affects 50% of all kidney transplant recipients.;" Fortin, Cardiovascular (heart) disease and kidney transplantation (2020). 

 4. How Am I Doing: Symptoms Associated With Cardiovascular Disease 

 The article gives us some practical tips for the early detection, care, treatment and prevention of cardiovascular diseases, post-kidney transplant by discussing symptoms to watch for and to call emergency in the event of a stroke. 

 Call 911 immediately if you have any of the following:

*heart attack symptoms: 

• Chest discomfort;

 • Sweating; 

• Upper body discomfort; 

• Nausea;

 • Shortness of breath;

 • Light-headedness. 

Stroke symptoms include:

 • Face drooping; 

• Inability to raise both arms; 

• Slurred speech.

 The literature suggested these symptoms are correct and the suggested steps to take are necessary. https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118; https://www.medicinenet.com/heart_disease_coronary_artery_disease/article.htm 

 Other suggested symptoms include: 

• Pain or pressure in the chest, which may indicate angina;

 • Pain or discomfort in the arms, left shoulder, elbows, jaw, or back; 

• Shortness of breath; 

• Nausea and fatigue;

• Lightheadedness or dizziness

 • Cold sweats 

https://www.medicalnewstoday.com/articles/257484  

5. What Can I Do To Decrease The Risk For Cardiovascular Disease 

 This section of the study discusses preventive steps we can take to avoid the risk of cardiovascular diseases as kidney transplant patients. It's the strongest section of the paper.

 Those steps include: 

 "1. Stop smoking if you are a smoke 

2. Take your medication for high blood pressure, diabetes, and cholesterol as prescribed.

 3. Monitor your blood sugar and your blood pressure and talk to your healthcare provider when they are not within the normal range. 

 4. Adopt healthy eating habits: a. 7-10 vegetables and fruits servings per day; 

 b. Eat whole grain foods; 

 c. Eat at least 2 servings of fish per week and include beans, lentils and tofu as part of your diet.

 d. When you eat meat, choose lean meat and keep your portion under 4 oz. 

 5. Be active: 150 minutes or more of moderate to vigorous intensity physical activities. 6. Maintain a healthy weight." 

 6. How Do I Decrease The Risk For Cardiovascular Disease 

 The advice given here is basically to work with your doctor and post-transplant team. This is great advice. 

Advice included: 

• Get your physician's help with medications to maintain correct blood pressure and blood sugar levels; 

• Hire a nutritionist to utilize a specific diet for your needs; 

• Monitor your physical activity with a smart watch or pedometer; & 

• Consult with a physiotherapist or kinesiologist to help you reach activity goals. 

You can also find expert help through the American Heart Association, with their experts who can perform a cardiac risk assessment, https://edhub.ama-assn.org/society-hospital-medicine/interactive/18297523; https://labtestsonline.org/tests/cardiac-risk-assessment; https://jamanetwork.com/journals/jama/article-abstract/2768470 and consult with the NIH's National Heart, Lung and Blood Institute online for additional advice and expertise. https://www.nhlbi.nih.gov/health-topics/heart-failure

 7. Conclusion

 This is an excellent paper on a subject that is not very well known, especially to kidney transplant patients. It is disturbing to me that this is not discussed more frequently and in more detail with kidney transplant patients. It is direct and to the point; an easy read that is comprehensive. There are few, if any weaknesses here. 

 • Relevance of Content 

The content is extremely relevant because of the prevalence of cardiovascular issues with Kidney transplant patients. 

 • Usefulness of Content 

The content is exceptionally useful. In particular, the section on prevention is highly useful. The advice given here should be followed by all kidney transplant patients.

 • Clarity of Content 

This is a strong point of the article, it is easy to understand. The content is exceptionally clear.

 • Applicability of Information 

The information related in the study is exceptionally applicable. This is 'must know information for kidney transplant patients. 

 My overall assessment is this is a meaningful article with essential information for kidney transplant patients.