Risk factors for reaching renal endpoints in the assessment of Lescol in renal transplantation (ALERT) trial.
BACKGROUND
The aim of the study was to identity risk factors for long-term renal transplant function and development of chronic allograft nephropathy (CAN) in renal transplant recipients included in the Assessment of Lescol in Renal Transplantation (ALERT) trial.


METHODS
The ALERT trial was a randomized, double-blind, placebo-controlled study of the effect of fluvastatin, 40 and 80 mg/day, in renal transplant recipients who were randomized to receive fluvastatin (Lescol) (n = 1,050) or placebo (n = 1,052) over 5 to 6 years of follow-up. Renal endpoints including graft loss or doubling of serum creatinine or death were analyzed by univariate and multivariate regression analysis in the placebo group.


RESULTS
There were 137 graft losses (13.5%) in the placebo group, mainly caused by CAN (82%). Univariate risk factors for graft loss or doubling of serum creatinine were as follows: serum creatinine, proteinuria, hypertension, pulse pressure, time since transplantation, donor age, human leukocyte antigen-DR mismatches, treatment for rejection, low high-density lipoprotein cholesterol, and smoking. Multivariate analysis revealed independent risk factors for graft loss as follows: serum creatinine (relative risk [RR], 3.12 per 100-microM increase), proteinuria (RR, 1.64 per 1-g/24 hr increase), and pulse pressure (RR, 1.12 per 10 mm Hg), whereas age was a protective factor. With patient death in the composite endpoint, diabetes mellitus, smoking, age, and number of transplantations were also risk factors.


CONCLUSIONS
Independent risk factors for graft loss or doubling of serum creatinine or patient death are mainly related to renal transplant function, proteinuria, and blood pressure, which emphasizes the importance of renoprotective treatment regimens in this population.
Fellström
Bengt
B
Department of Medical Science, Renal Science, Renal Unit, University Hospital, Uppsala, Sweden. bengt.fellstrom@medsci.uu.se
Holdaas
Hallvard
H
Jardine
Alan G
AG
Nyberg
Gudrun
G
Grönhagen-Riska
Carola
C
Madsen
Søren
S
Neumayer
Hans-Hellmut
HH
Cole
Edward
E
Maes
Bart
B
Ambühl
Patrice
P
Olsson
Anders G
AG
Staffler
Beatrix
B
Pedersen
Terje R
TR
D000328:Adult; D000704:Analysis of Variance; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005229:Fatty Acids, Monounsaturated / Q000627:therapeutic use*; D005260:Female; D000077340:Fluvastatin; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007211:Indoles / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010919:Placebos; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000473:pathology
D005229:Fatty Acids, Monounsaturated; D007166:Immunosuppressive Agents; D007211:Indoles; D010919:Placebos; D000077340:Fluvastatin; D003404:Creatinine