Non-immunologic intervention in chronic allograft nephropathy.
BACKGROUND
Chronic allograft nephropathy is the main cause of late graft loss. It has been suggested that both alloantigen-dependent and alloantigen-independent factors influence the development of progressive transplant failure. The present study analyzed the importance of non-immunologic factors in the progression of kidney disease in transplant patients, with the emphasis on well-established risk factors for progression in native kidneys.


METHODS
A retrospective analysis was performed on 485 renal transplant patients who had functioning kidneys for at least 1 year. We investigated whether the initial presence and subsequent maintenance of proteinuria, hypertension, anemia, hyperlipidemia, and hyperparathyroidism influenced the progression of transplant failure. To analyze the relative effects of these factors, patients were categorized into two groups: group A had a baseline serum creatinine concentration of less than 1.5 mg/dL, and group B had a baseline serum creatinine concentration of 1.5 to 3 mg/dL.


RESULTS
High urine protein excretion was a significant independent risk factor for progression of renal failure (group A: relative risk, 3.73; 95% confidence interval [CI], 2.24-6.21; group B: relative risk, 4.01; 95% CI, 2.51-6.39). Hypertension was also a significant independent risk factor for progression, but the risk was lower than for proteinuria (group A: relative risk, 1.2; 95% CI, 1.04-1.75; group B: relative risk, 1.20; 95% CI, 1.02-2.1). Anemia, hyperlipidemia, and hyperparathyroidism had no influence on the progression of renal failure.


CONCLUSIONS
Our results show strong independent relationships between high blood pressure, urine protein excretion, and the relative risk of chronic progression of renal failure, as described for native kidney disease. These factors are potentially modifiable and are therefore attractive targets for therapeutic targets.
Arias
Manuel
M
Nephrology Service, Universitary Hospital Marques de Valdecilla, Santander, Spain. nefffg@humv.es
Fernández-Fresnedo
Gema
G
Rodrigo
Emilio
E
Ruiz
Juan Carlos
JC
González-Cotorruelo
Julio
J
Gómez-Alamillo
Carlos
C
D000328:Adult; D000740:Anemia / Q000503:physiopathology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D006949:Hyperlipidemias / Q000503:physiopathology; D006961:Hyperparathyroidism / Q000503:physiopathology; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000188:drug therapy / Q000503:physiopathology; D051437:Renal Insufficiency / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000009:adverse effects
D000959:Antihypertensive Agents; D003404:Creatinine