Proteinuria >0.5 g/d, a prevalent prognostic factor for patient and graft survival in kidney transplantation.
Proteinuria >0.5 g/d (HP) and serum creatinine (Scr) >120 micromol/L (HSC) at three months, two and five yr were compared as prognostic factors in kidney transplantation. We retrospectively analyzed 454 first transplants (follow-up: 100 +/- 3.2 months). Donor/recipient age, sex, panel reactive antibody (PRA), HLA mismatches, cold ischemia time, delayed graft function, acute rejection, blood pressure and its treatment, diabetes and anti-calcineurin use were also evaluated. Cox proportional hazard regression with time-dependent covariates to control for potentially confounding factors was used to analyze survival. The Kaplan-Meier product-limit estimate for survival according to urine protein excretion (< or = or >0.5 g/d) or Scr (< or = or >120 micromol/L) along with the log-rank test for all comparisons were computed. Statistical significance was set with p-value < 0.05.


RESULTS
HSC is a prognostic factor of graft survival (HR: 2.54; 95% CI: 1.98-3.10; p < 0.01) only at five yr, but it does not predict mortality at any period. HP at three months (HR: 2.07; 95% CI: 1.70-2.43; p < 0.001) and at two yr 3.03 (2.54-3.51; p < 0.001) significantly predicts graft failure. HP at two yr is the prevailingly prognostic factor of patient survival in kidney transplantation (HR: 3.30; 95% CI: 1.94-5.62; p < 0.0001).
Cantarovich
Félix
F
Hôpital Necker, Service de Transplantation Adultes, Paris, France. felix.cantarovich@orange.f
Martinez
Frank
F
Heguilen
Ricardo
R
Thervet
Eric
E
Mamzer-Bruneel
Marie-France
MF
Gonzalez
Claudio
C
Legendre
Christophe
C
D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality* / Q000502:physiology*; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011507:Proteinuria; D012189:Retrospective Studies; D012307:Risk Factors
D003404:Creatinine