title: A thirty percent chronic decline in inverse serum creatinine is an excellent predictor of late renal allograft failure.
abstract: We previously reported that the percentage of change in inverse serum creatinine (Delta1/Cr) was the best of several time-dependent serum creatinine-derived predictors of renal allograft failure in patients not administered cyclosporine (CsA). To further validate the utility of Delta1/Cr, we collected creatinine levels (mean, 90.7 +/- 45.2 creatinine measurements) in 100 patients treated for 6.7 +/- 5.9 years with CsA. We also validated Delta1/Cr using a limited creatinine-sampling strategy, then performed multivariate Cox proportional hazards analysis of 1,663 transplantations. A time-dependent covariate determined by the date of first chronic decline (excluding creatinine levels from periods of acute rejection) in Delta1/Cr to less than -30% of baseline similarly was predictive of graft failure in 101 patients treated without CsA (relative risk, 5.04; 95% confidence interval, 2.18 to 11.6; P = 0.0002) and 100 patients treated with CsA (relative risk, 5.02; 95% confidence interval, 2.50 to 10.1; P < 0.0001). A limited creatinine-sampling strategy (measured at 1 week, 1, 3, 6, 12, 18, 24, and 36 months, and each year thereafter) reduced the ability of Delta1/Cr less than -30% to predict graft failure. In 1,663 patients, Delta1/Cr less than -30% first occurred a median of 1.0 years posttransplantation (n = 792 of 1,663 patients) and 3.0 years before graft failure (n = 478 of 897 patients with graft failure). In a multivariate model (n = 1,663) that included baseline function, acute rejection, and other covariates, Delta1/Cr less than -30% was a strong independent predictor of graft failure (relative risk, 2.56; 95% confidence interval, 2.12 to 3.09; P < 0.0001). Thus, Delta1/Cr less than -30% is an excellent predictor of graft failure that is similarly predictive in patients treated with and without CsA. A limited sampling strategy for creatinine diminishes, but does not negate, the usefulness of Delta1/Cr less than -30%.
authors.affiliation: Department of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA. kasis001@umn.edu
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.forename: Magdalena Adeva
authors.initials: MA
authors.lastname: Andany
authors.forename: Barbara
authors.initials: B
authors.lastname: Danielson
mesh_terms: D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D016572:Cyclosporine / Q000627:therapeutic use; D006084:Graft Rejection / Q000097:blood* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D015999:Multivariate Analysis; D010865:Pilot Projects; D011379:Prognosis; D014184:Transplantation, Homologous
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine