Prevalence and severity of renal dysfunction among 1062 heart transplant patients according to criteria based on serum creatinine and estimated glomerular filtration rate: results from the CAPRI study.
Chronic kidney disease (CKD) is staged on the basis of glomerular filtration rate; generally, the MDRD study estimate, eGFR, is used. Renal dysfunction (RD) in heart transplant (HT) patients is often evaluated solely in terms of serum creatinine (SCr). In a cross-sectional, 14-center study of 1062 stable adult HT patients aged 59.1±12.5 yr (82.3% men), RD was graded as absent-or-mild (AoM), moderate, or severe (this last including dialysis and kidney graft) by two classifications: SCr-RD (SCr cutoffs 1.6 and 2.5 mg/dL) and eGFR-RD (eGFR cutoffs 60 and 30 mL/min/1.73 m2). SCr-RD was AoM in 68.5% of patients, moderate in 24.9%, and severe in 6.7%; eGFR-RD, AoM in 38.6%, moderate in 52.2%, severe in 9.2%. Among patients evaluated <2.7, 2.7-6.2, 6.2-9.5 and >9.5 yr post-HT (the periods defined by time-since-transplant quartiles), AoM/moderate/severe RD prevalences were <2.7, SCr-RD 74/21/5%, eGFR-RD 47/47/6%; 2.7-6.2, SCr-RD 73/22/5%, eGFR-RD 37/56/7%; 6.2-9.5, SCr-RD 69/24/7%, eGFR-RD 37/54/9%; >9.5, SCr-RD 58/32/10%, eGFR-RD 32/52/16%. The prevalence of severe RD increases with time since transplant. If the usual CKD stages are appropriate for HT patients, the need for less nephrotoxic immunosuppressants and other renoprotective measures is greater than is suggested by direct SCr-based grading, which should be abandoned as excessively insensitive.
Crespo-Leiro
Maria G
MG
Hospital Universitario A Coruña, Instituto Ciencias de la Salud, Universidad de La Coruña, La Coruña, Spain. Marisa.Crespo.Leiro@sergas.es
Delgado
Juan F
JF
Paniagua
Maria J
MJ
Vázquez de Prada
Jose A
JA
Fernandez-Yañez
Juan
J
Almenar
Luis
L
Diaz-Molina
Beatriz
B
Roig
Eulalia
E
Arizón
Jose M
JM
Alonso-Pulpón
Luis
L
Garrido
Iris P
IP
Sanz
Maria Luisa
ML
de la Fuente
Luis
L
Mirabet
Sonia
S
Manito
Nicolas
N
Muñiz
Javier
J
D000293:Adolescent; D000328:Adult; D003404:Creatinine / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D016027:Heart Transplantation; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
D003404:Creatinine