Refining cardiovascular risk prediction after renal transplantation: a cross-sectional study focusing on NT-proBNP and the revised cardiac risk index.

BACKGROUND: Cardiovascular complications significantly influence outcomes in kidney transplant recipients, predominantly driven by the multifactorial risks associated with end-stage renal disease (ESRD). This study investigates the utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the revised cardiac risk index (RCRI) in predicting cardiovascular events (CVE) after kidney transplantation (KT), aiming to refine risk assessment and management strategies pre-transplantation. METHODS: From May 2021 to May 2023, 122 ESRD patients scheduled for kidney transplantation were enrolled in a prospective cohort study at a single center. Pre-transplant NT-proBNP levels and RCRI scores were evaluated for their predictive accuracy for in-hospital and 1-month post-transplant CVEs. RESULTS: The median age of participants was 47.7 years. Pre-existing hypertension was present in 80.3%, diabetes in 26.2%, smoking history in 9.0%, and cardiovascular disease in 23%. A revised cardiac risk index (RCRI) score of 1 was present in 64.8% of cases. Over half of the patients had NT-proBNP levels above 1200 pg/mL. Patients with higher NT-proBNP levels exhibited lower left ventricular ejection fraction (LVEF) and higher systolic pulmonary artery pressure (PAP). Patients who experienced at least one CVE were older, with a trend toward a higher NT-proBNP level in this population. The RCRI showed no significant difference between patients with NT-proBNP levels above or below 1200 pg/mL. Still, it differed among patients with at least one CVE compared to those without. After adjusting the NT-proBNP level, RCRI = 3 had an odds ratio of 9.6 (1.6-57.4) for cardiovascular endpoints compared to those with RCRI 1 and 2. CONCLUSION: NT-proBNP alone could not predict 30-day CVE after KT. Regarding the trend toward higher NT-proBNP levels in individuals with at least one CVE, further studies with a larger sample size should be done to assess whether integrating NT-proBNP and RCRI before KT can improve cardiovascular outcomes in this high-risk population.