Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/29870
Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: The Associations of Endotoxemia With Systemic Inflammation, Endothelial Activation, and Cardiovascular Outcome in Kidney Transplantation
Author(s): Chan, Winnie
Bosch, Jos A
Phillips, Anna C
Chin, Shui Hao
Antonysunil, Adaikala
Inston, Nicholas
Moore, Sue
Kaur, Okdeep
McTernan, Philip G
Borrows, Richard
Contact Email: a.c.whittaker@stir.ac.uk
Keywords: Endotoxemia
Inflammation
Endothelial Activation
Cardiovascular
Kidney Transplantation
Issue Date: Jan-2018
Citation: Chan W, Bosch JA, Phillips AC, Chin SH, Antonysunil A, Inston N, Moore S, Kaur O, McTernan PG & Borrows R (2018) The Associations of Endotoxemia With Systemic Inflammation, Endothelial Activation, and Cardiovascular Outcome in Kidney Transplantation. Journal of Renal Nutrition, 28 (1), pp. 13-27. https://doi.org/10.1053/j.jrn.2017.06.004
Abstract: Objective Cardiovascular disease is the leading cause of death in kidney transplant recipients (KTRs), yet incompletely accountable by traditional risk factors. Inflammation is an unconventional cardiovascular risk factor, with gut-derived endotoxemia potentially driving inflammation and endothelial disease. Comparable data are lacking in kidney transplantation. This study investigated the associations of endotoxemia with inflammation, endothelial activation, and 5-year cardiovascular events in KTRs. Determinants of endotoxemia were also explored. Design and Methods This is a single-center cross-sectional study with prospective follow-up from a prevalent cohort of 128 KTRs. Main Outcome Measures Demographic, nutritional and clinical predictors of inflammation (high-sensitivity C-reactive protein [hsCRP]), endothelial activation (sE-selectin), and endotoxemia (endotoxin) were assessed. Follow-up data on 5-year cardiovascular event rates were collected. Results Endotoxemia (P = .03), reduced 25-hydroxyvitamin D (P = .04), high fructose intake (P < .001), decreased fiber intake (P < .001), and abdominal obesity (P = .002) were independently associated with elevated hsCRP. In turn, endotoxemia (P = .007) and increasing hsCRP (P = .02) were both independently associated with raised sE-selectin. Furthermore, endotoxemia predicted increased cardiovascular event rate (P = .02), independent of hsCRP and a global measure of cardiovascular risk estimated by a validated algorithm of 7-year risk for major adverse cardiac events in kidney transplantation. Determinants of endotoxemia included reduced 25-hydroxyvitamin D (P < .001), hypertriglyceridemia (P < .001), increased fructose intake (P = .01), and abdominal obesity (P = .01). Conclusions Endotoxemia in KTRs contributes to inflammation, endothelial activation, and increased cardiovascular events. This study highlights the clinical relevance of endotoxemia in KTRs, suggesting future interventional targets.
DOI Link: 10.1053/j.jrn.2017.06.004
Rights: Accepted refereed manuscript of: Chan W, Bosch JA, Phillips AC, Chin SH, Antonysunil A, Inston N, Moore S, Kaur O, McTernan PG & Borrows R (2018) The Associations of Endotoxemia With Systemic Inflammation, Endothelial Activation, and Cardiovascular Outcome in Kidney Transplantation. Journal of Renal Nutrition, 28 (1), pp. 13-27. DOI: https://doi.org/10.1053/j.jrn.2017.06.004 © 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Licence URL(s): http://creativecommons.org/licenses/by-nc-nd/4.0/

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