The modification of diet in renal disease (MDRD) and the prediction of kidney outcomes after lung transplantation.
BACKGROUND
Chronic kidney disease (CKD) is prevalent after lung transplantation. This study evaluated the ability of the 24-hour urine creatinine clearance (CrCl) and the Modification of Diet in Renal Disease (MDRD) equation at the time of listing to predict CKD after lung transplantation and to determine risk factors for CKD.


METHODS
This was a retrospective cohort study of 122 patients who underwent lung transplantation at Columbia Presbyterian Medical Center between May 2002 and August 2006. The primary end point was CKD Stage 3 or higher, defined as glomerular filtration rate (GFR) </= 59 ml/min/1.73 m(2) or renal replacement therapy, for at least 3 months.


RESULTS
Patients were a mean age of 51 +/- 14 years, 55% women, and 83% non-Hispanic white. CKD developed in 62% by 1 year after lung transplantation. Older age, female gender, a diagnosis of sarcoidosis, and diabetes mellitus independently increased the risk of CKD (all p < 0.05). The MDRD equation was significantly better than CrCl at predicting CKD Stage 3 or higher at 1 year after transplantation, with an area under the receiver operating characteristic curve of 0.71 for MDRD (95% confidence interval [CI], 0.61-0.81) and 0.51 for CrCl (95% CI, 0.40-0.61) (P < 0.001).


CONCLUSIONS
Older age, female gender, and diabetes mellitus increased the risk of developing CKD after lung transplant. The MDRD estimate of GFR at listing was a better predictor of CKD than CrCl. MDRD estimates should be used during lung transplant evaluation for risk stratification for CKD.
Al-Naamani
Nadine
N
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Maarouf
Omar H
OH
Wilt
Jessie S
JS
Bacchetta
Matthew
M
D'Ovidio
Frank
F
Sonett
Joshua R
JR
Arcasoy
Selim M
SM
Lederer
David J
DJ
Nickolas
Thomas L
TL
Kawut
Steven M
SM
D000328:Adult; D000368:Aged; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D005247:Feeding Behavior; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000178:diet therapy* / Q000453:epidemiology / Q000503:physiopathology*; D016040:Lung Transplantation / Q000009:adverse effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D003404:Creatinine