) 35 50% [3] azathioprine (cyclosporine)
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1 60 100% calcineurin inhibitors ( [1] tacrolimus) ( ) 35 50% [3] azathioprine (cyclosporine) 50 70% 65 85% [4] 50% [2] [5] 140/90 mmhg ( ) [4] The Nation- al Kidney Foundation Task Force 130/85 mmhg 125/75 mmhg [6] (hyperhomocysteinemia) (Calcium channel blocker CCB) Angiotensin-converting enzyme inhibiter (ACEI) angiotensin
2 (ARB) ACEI ( verapamil, diltiazem, nicardipine) (LDL) (HDL) [4] (Beta-blockers) ACEI [4] National Kidney Foundation (NKF) 100 mg/ dl ( 7% 200 mg/day) 100 mg/dl 130 mg/dl HMG-CoA reductase inhibitor calcineurin inhibitor (LDL) HMG-CoA reductase inhibitor 60% 35% (HDL) 15% [7] mg/dl statin fluvastatin pravastatin 160 mg/dl atorvastatin [5] [8-9] tacrolimus tacrolimus [10] 100 mg/dl statin sirolimus (hypertriglyceridemia) tacrolimus Kasiske tacrolimus [14] [11] Kasiske rapamycin 200 mg/dl [12] Aker (10% 15%) 180 mg/dl 2.3 [13] Bile acid sequestrants
3 statin bile tarcolimus acid sequestrants Fibric tarcolimus acid analogs statin Nicotinic acid (ESRD) 5.9% 8.8% 10.5% 16.9% [17] 50% [15] 10% 5% [15] 2 Aker 4.3 [13] Kasiske 3 [16] calcineurin inhibitors (Impaired glucose tolerance) (Post-transplant Diabetes mellitus (PTDM)) (PTDM) 52% Framingham Heart Study 69% 34% ( i nsul in Framingham Heart Study resistance)
4 1.06 [18] PAI-1 14% 26% 10% 28 48% PAI-1 2% 12% Body-Mass-Index (BMI) 30 kg/ m 2 NIDDM (BMI fibrinolysis 25 kg/m 2 ) (1.34 ) (Fibrinolysis) PAI-1 PAI-1 PAI-1 (Hypehomocysteinemia) azathiporine (Homocysteine) PAI-1 (GFR) Plasminogen- Activator-Inhibitor-1 (PAI-1)
5 cardiac stress test 7.5 ACEI Minnesota [18] ( 70%) : 1. Arend SM, Mallat MJ, Westendorp RJ, et al: Patient survival after renal transplantation; more than 25 years follow-up. Nephrol Dial Transplant 1997; 12: Lindholm A, Albrechtsen D, Frodin L, et al: Ischemic heart disease-major cause of death and graft loss after renal transplantation in Scandinavia. Transplantation 1995; 60: Jose M. Morales: Influence of the new immunosuppressive combinations on arterial hypertension after renal transplantation. Kidney Int 2002; (Suppl 82): S Kasiske BL, Vazquez MA, Harmon We, et al: For the American Society of Transplantation: Recommendations for the ourpatient surveillance of renal transplant recipients. J Am Soc Nephrol 2000; (Suppl 11): S Kasiske BL: Ischemic heart disease after renal transplantation. Kidney Int 2002; 61: Mailloux LU, Levey AS: Hypertension in patients with chronic renal disease. Am J Kidney Dis 1998; (Suppl 32): S Kasiske BL: Hyperlipidemia in patients with chronic renal risease. Am J Kidney Dis 1998; (Suppl 32): S Dimeny E, Wahlberg J, Lithell H, Fellstrom B: Hyperlipidemia
6 in renal transplantation-risk factor for long-term graft outcome. Eur J Clin Invest 1995; 25: Schena A, Di Paolo S, Morrone LF, et al: Are lipid-dependent indicators of cardiovascular risk affected by renal transplantation? Clin Transplant 2000; 14: Henry ML: Cyclosporine and tacrolimus (FK506): A comparison of efficacy and safety profiles. Clin Transplant 1999; 13: Kasiske BL: Risk factors for accelerated atherosclerosis in renal transplant recipients. Am J Med 1988; 84: Kasiske BL, Ohakkera HA, Rose J: Explained and unexplained ischemic heart disease risk after renal transplantation. J Am Soc Nephrol 2000; 11: Aker S, Ivens K, Grabensee B, Heering P: Cardiovascular risk factors and diseases after renal transplantation. Int Urol Nephrol 1998; 30: McCune TR, Thacker LR, II, Peters TG, et al: Effects of tacrolimus on hyperlipidemia after successful renal transplantation: A Southeastern Organ procurement Foundation multicenter clinical study. Transplantation 1998; 65: Manske CL, Wilson RF, Wang Y, Thomas W: Atherosclerotic vascular complications in diabetic transplant candidates. Am J Kidney Dis 1997; 29: Kasiske BL, Guuarro C, Massy ZA, et al: Cardiovascular disease after renal transplantation. J Am Soc Nephrol 1996; 7: Cosio FG, Pesavento TE, Osei K, et al: Post-transplant diabetes mellitus: Increasing incidence in renal allograft recipients transplanted in recent years. Kidney Int 2001; 59: Bostom AG, Kornenberg F, Gohh RY, et al: Chronic renal transplantation:a model for the hyperhomocysteinemia of renal insufficiency. Atherosclerosis 2001; 156: Manske CL, Wang Y, Rector T, et al: Coronary revasculisation in insulin-dependent diabetic patients with chronic renal failure. Lancet 1992; 340:
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