title: Elevated levels of C-reactive protein independently predict accelerated deterioration of graft function in renal transplant recipients.
abstract: BACKGROUND
  Chronic transplant dysfunction is characterized by a gradual decline in renal function with slowly rising serum creatinine. The underlying mechanism is thought to include inflammation and atherosclerosis. C-reactive protein (CRP) is a well-established marker of both inflammation and atherosclerosis. In this prospective study, we investigated whether CRP could be of use as a clinical marker for early identification of renal transplant recipients at increased risk of deterioration of graft function.
  
  
  METHODS
  In this prospective study, all participating patients (n = 606) visited the out-patient clinic at least once a year, and serum creatinine was assessed at every visit. Subjects with a follow-up of <1 year (n = 31) were excluded from analysis.
  
  
  RESULTS
  A total of 575 patients participated at a median (interquartile range) time of 5.9 (2.6-11.3) years post-transplantation. Median time of follow-up was 3.0 (2.4-3.4) years. Changes in serum creatinine during follow-up were -0.45 (-4.83-4.76) micromol/l/year in 172 subjects with CRP <1.0 mg/l, 1.04 (-3.36-6.12) micromol/l/year in 184 subjects with CRP 1.0-3.0 mg/l and 2.34 (-3.33-9.07) micromol/l/year in 219 subjects with CRP >3.0 mg/l (P < 0.05 for comparison of the three groups). Proteinuria (P = 0.003), CMV IgG titre (P = 0.01), donor age (P = 0.01), CRP concentration (P = 0.02), recipient age (P = 0.02) and recipient gender (P = 0.047) were independently associated with change in serum creatinine during follow-up in a multivariate analysis.
  
  
  CONCLUSIONS
  Elevated levels of CRP independently predict accelerated deterioration of graft function in renal transplant recipients >1 year post-transplantation. Further prospective studies are required to investigate whether early intervention can prevent deterioration of graft function in subjects with elevated levels of CRP.
authors.affiliation: Department of Medicine, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: Rutger M
authors.initials: RM
authors.lastname: van Ree
authors.forename: Leendert H
authors.initials: LH
authors.lastname: Oterdoom
authors.forename: Aiko P J
authors.initials: AP
authors.lastname: de Vries
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.forename: Jaap J Homan
authors.initials: JJ
authors.lastname: van der Heide
authors.forename: Willem J
authors.initials: WJ
authors.lastname: van Son
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Ploeg
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Reinold O B
authors.initials: RO
authors.lastname: Gans
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000096:biosynthesis*; D002318:Cardiovascular Diseases / Q000378:metabolism; D003404:Creatinine / Q000097:blood; D003587:Cytomegalovirus / Q000378:metabolism; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis
chemical_list: D007166:Immunosuppressive Agents; D002097:C-Reactive Protein; D003404:Creatinine