Micro RNA-192 Is Negatively Associated With Cardiovascular Events Among Wait-Listed Potential Kidney Transplant Recipients on Hemodialysis Over a 5-year Follow-up Period

Novel Predictors of Major Adverse Cardiovascular Events in Renal Transplant Patients: A Systematic Review and Meta-Analysis

Adult patients with a prior renal transplantation are at increased risk of accelerated cardiovascular disease. This study aims to identify key clinical and biochemical predictors of major adverse cardiovascular events (MACEs) in this population. Understanding these predictors may improve risk stratification and enhance long-term outcomes for kidney transplant recipients. A systematic literature search of medical databases was performed using PRISMA principles to identify all relevant studies assessing clinical and biochemical parameters in adult patients with a prior renal transplantation (2000-2024; English only; PROSPERO registration CRD42024596207). Data for a range of clinical and biochemical parameters were individually extracted, and those with low heterogeneity were then meta-analysed using a random-effects model for overall effect size and assessed through standardised mean difference (SMD) and odds ratios (ORs). The primary outcomes assessed were fatal or non-fatal cardiovascular events occurring after renal transplantation during hospitalisation and up to 10 years post discharge. Of 506 screened studies, 17 peer-reviewed articles met inclusion criteria and included a total of 181,938 renal transplant patients. The key novel predictors of MACE included pre-transplant haemodialysis (OR 2.562, 95% CI = 1.585-4.139, p < 0.001) and delayed graft function (OR 2.113, 95% CI = 1.397-3.198, p < 0.001). Importantly, transplant from a living donor (OR 0.463, 95% CI = 0.393-0.546, p < 0.001) was a protective factor. Traditional cardiovascular risk factor profiles were all predictors of MACE events (p < 0.05). This study identified several traditional and novel predictors of cardiovascular events in patients with pre-existing renal transplantation. Early recognition of these high-risk clinical predictors should prompt more aggressive monitoring and treatment.

The Impact of Physical Exercise on microRNAs in Hemodialysis Patients: A Review and a Protocol for an Ancillary Study

Physical inactivity is considered a significant risk factor for mortality and morbidity among chronic hemodialysis (HD) patients. Therefore, physical exercise is recommended in the treatment of HD patients. Although the beneficial effects of physical exercise in HD patients are well-described in the literature, the underlying physiological mechanisms still need to be fully understood. Recently, microRNAs (miRNAs) have emerged as potential mediators of the therapeutic effects of physical exercise in healthy individuals. miRNAs are short, single-stranded, noncoding RNAs involved in gene expression regulation. Specifically, upon forming the RNA-induced silencing complex, miRNAs selectively bind to specific miRNAs within cells, reducing gene expression. miRNAs can be secreted by cells in an accessible form or enclosed within exosomes or extracellular vesicles. They can be detected in various body fluids, including serum (circulating miRNAs), facilitating the study of their diverse expression. Currently, there is no available data regarding the impact of physical exercise on the expression of miRNAs involved in osteogenic differentiation, a fundamental mechanism in the development of vascular calcification, for HD patients. Therefore, we have designed an observational and longitudinal case-control study to evaluate the expression of miR-9 and miR-30b in HD patients participating in a 3-month interdialytic physical exercise program. This paper aims to present the study protocol and review the expression of circulating miRNAs in HD patients and their modulation through physical exercise.