Achieving chronic kidney disease treatment targets in renal transplant recipients: results from a cross-sectional study in Spain.
BACKGROUND
Kidney transplant recipients are considered to have chronic kidney disease (CKD) irrespective of glomerular filtration rate (GFR) or presence or absence of markers of kidney damage. The aim of this work was to investigate the prevalence of CKD-stages and whether the guidelines for general population (Kidney Disease Outcomes Quality Initiative) are routinely followed in kidney transplant in Spain.


METHODS
Two thousand one hundred sixty renal transplant recipients followed up at the outpatient clinics in 4 University Hospitals were included. The estimated GFR (eGFR) was calculated according to the abbreviated modification of diet in renal disease equation, and the patients were classified following the Kidney Disease Outcomes Quality Initiative stages.


RESULTS
Chronic kidney failure (eGFR <60 mL/min/1.73 m) was present in 1505 patients (69.7%), 54.4% were 3T-stage (eGFR 30-59); 13.0% were 4T-stage (eGFR 15-30), and 2.3% were 5T-stage. The prevalence of severe anemia increased from 4.1% in 1T-stage to 44% in 5T-stage (P=0.000) as did the percentage of patients on erythropoiesis-stimulating agents from 1.3% to 68% (P=0.000). The intact parathyroid hormone levels increased as graft function declined and 45% of 5T-stage patients had intact parathyroid hormone levels more than 300. Calcium and vitamin D supplements were administered to 50% and 40% of patients, respectively. Hypertension was quite common and increased with the progression of CKD. The mean total cholesterol was 192+/-39 mg/dL, and the levels did not increase with the decline in graft function. Approximately 60% had suboptimal cholesterol despite 50% being on statins treatment.


CONCLUSIONS
CKD and their complications were prevalent in renal transplant recipients. The control of some of these complications is far below targets established for nontransplant CKD patients despite a progressive intensification of therapy as graft function declines.
Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain. rmarcen.hrc@salud.madrid.org
Roberto
R
Marcén
Domingo
D
del Castillo
Luis
L
Capdevila
Gema
G
Fernandez-Fresnedo
Emilio
E
Rodrigo
Carmen
C
Cantarell
Ana
A
Fernández-Rodriguez
María O
MO
López-Oliva
Joaquin
J
Camps
Pedro
P
Aljama
Joaquín
J
Ortuño
Manuel
M
Arias
D000328:Adult; D000740:Anemia / Q000453:epidemiology / Q000503:physiopathology; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000502:physiology / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000628:therapy; D012720:Severity of Illness Index; D013030:Spain; D014019:Tissue Donors / Q000706:statistics & numerical data
D003404:Creatinine