title: The burden of chronic kidney disease in long-term liver transplant recipients.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is an important risk factor for morbidity and mortality post-liver transplantation (OLT). This study focused on investigating the incidence and risk factors associated with the development CKD after OLT.
  
  
  METHODS
  We performed a retrospective cohort study of recipients followed at least 5 years at our institution. CKD was diagnosed and classified according to National Kidney Foundation and the Kidney Disease Outcomes Quality Initiative guidelines.
  
  
  RESULTS
  There were 231 patients, 64% men, 67% Caucasian, 16% African-American, and 17% others, with a mean age of 56 +/- 13 years. The mean glomerular filtration rate (GFR) of the population was 56 +/- 28 mL/min/1.73 m2. CKD was defined as GFR less than 60 mL/min; 144 patients (61%) were identified as having CKD. When these patients were compared to the non-CKD group, the former were significantly older (62 +/- 9 vs 52 +/- 12 years, P = .03), more likely to be hypertensive (59% vs 38%, P = .003), and required more antihypertensive medications (0.83 +/- 0.81 vs 0.52 +/- 0.77, P = .02); 26% of all patients had diabetes. However, the incidence of diabetes (43.3% vs 19.3%, P = .02) as well as the incidence of insulin dependency (21.6% vs 12.5%, P = .001) was significantly higher in the CKD population. Mean uric acid levels were higher in CKD patients compared to non-CKD patients (8.00 +/- 2.00 mg/dL vs 6.70 +/- 1.99 mg/dL respectively, P = .001); patients with uric acid more than 6.0 had a 1.7 risk of having CKD.
  
  
  CONCLUSIONS
  CKD defined as GFR < 60 mL/min is highly prevalent in long-term OLT survivors. Older age, elevated systolic blood pressure, insulin-dependent diabetes mellitus, and elevated uric acid levels are independently associated with CKD.
authors.affiliation: Division of Nephrology, The Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: G
authors.initials: G
authors.lastname: de Boccardo
authors.forename: J-Y
authors.initials: JY
authors.lastname: Kim
authors.forename: T D
authors.initials: TD
authors.lastname: Schiano
authors.forename: R
authors.initials: R
authors.lastname: Maurette
authors.forename: R
authors.initials: R
authors.lastname: Gagliardi
authors.forename: B
authors.initials: B
authors.lastname: Murphy
authors.forename: S
authors.initials: S
authors.lastname: Emre
authors.forename: E
authors.initials: E
authors.lastname: Akalin
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D003404:Creatinine