Change in serum creatinine levels between 6 and 12 months and kidney graft survival: influence of proteinuria.
Renal function within the first year after transplantation has been shown to be an important parameter influencing long-term survival. In this study, we examined the relationship between long-term outcome in 365 renal transplants and renal function in the first year, expressed as serum creatinine (SCr) level at 6 months and at 1 year as well as namely deltaCr, the change in SCr between 6 months and 1 year. In addition, we examined the influence of the presence of proteinuria as a predictive factor for a worse evolution. Graft survival was worse among patients with higher deltaCr, especially among those who developed proteinuria. In a Cox regression analysis of long-term graft survival, both deltaCr and proteinuria were important predictors of half-life. The risk of graft loss when deltaCr >0.3 was 2.65 (1.8-3.8; P < .000), whereas the risk increased to 5.67 (3.3-9.4; P < .00) when proteinuria was present. In conclusion, deltaCr values predict long-term graft survival. Patients who developed proteinuria were at higher risk for graft loss compared with those without proteinuria. By using a combination of SCr and deltaCr with proteinuria, it is possible to identify a subset of transplant recipients with a predictably shortened half-life.
Fernández-Fresnedo
G
G
Nephrology Unit, University Hospital Marqués de Valdecilla, Santander, Spain. nefffg@humv.es
Rodrigo
E
E
de Francisco
A L M
AL
Escallada
R
R
Ruiz
J C
JC
Cotorruelo
J C
JC
Zubimendi
J A
JA
Arias
M
M
D000328:Adult; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood* / Q000378:metabolism; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006207:Half-Life; D006801:Humans; D016030:Kidney Transplantation / Q000502:physiology*; D012189:Retrospective Studies; D013997:Time Factors
D015415:Biomarkers; D003404:Creatinine