title: Influence of C-reactive protein and urinary protein excretion on prediction of graft failure and mortality by serum albumin in renal transplant recipients.
abstract: BACKGROUND
  Hypoalbuminemia is an established predictor of poor outcome in renal transplant recipients (RTR). It is considered to reflect inflammation, poor nutritional status, or proteinuria. We explored the roles of high-sensitivity C-reactive protein (hsCRP) and urinary protein excretion in prediction of graft failure and mortality by serum albumin in RTR.
  
  
  METHODS
  We included 605 RTR at a median (interquartile range) time of 6.0 years (2.5-11.5 years) after transplantation for baseline measurements.
  
  
  RESULTS
  At baseline, urinary protein excretion (beta=-0.242, P<0.0001), hsCRP concentration (beta=-0.207, P<0.0001), recipient age (beta=-0.115, P=0.004), living kidney donor (beta=0.100, P=0.01), and a history of myocardial infarction (beta=-0.084, P=0.03) were independently related to serum albumin. Prospectively, 94 RTR died and 42 had graft failure during 5.3 years (4.7-5.7 years) of follow-up. After adjustment for potential confounders, including hsCRP and urinary protein excretion in Cox-regression analyses, low serum albumin was significantly associated with graft failure (hazard ratio=0.34 [95% confidence interval=0.15-0.76] per g/dL, P=0.008) and mortality (hazard ratio=0.43 [95% confidence interval=0.24-0.78] per g/dL, P=0.005), with significant modification of the effect of serum albumin on graft failure by urinary protein excretion (P=0.003).
  
  
  CONCLUSIONS
  Low serum albumin concentrations predict graft failure and mortality in RTR independent of hsCRP and urinary protein excretion. The effect of serum albumin on graft failure is strongly modified by urinary protein excretion. These results suggest that chronic low-grade inflammation is not an important mechanism underlying inverse associations of serum albumin with graft failure and mortality. They also suggest that proteinuria is involved in the association of low serum albumin with graft failure.
authors.affiliation: University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
authors.forename: Rutger M
authors.initials: RM
authors.lastname: van Ree
authors.forename: Sascha
authors.initials: S
authors.lastname: Gross
authors.forename: Dorien M
authors.initials: DM
authors.lastname: Zelle
authors.forename: Jaap J Homan
authors.initials: JJ
authors.lastname: van der Heide
authors.forename: Jan P
authors.initials: JP
authors.lastname: Schouten
authors.forename: Willem J
authors.initials: WJ
authors.lastname: van Son
authors.forename: Reinold O B
authors.initials: RO
authors.lastname: Gans
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
mesh_terms: D000328:Adult; D001794:Blood Pressure; D001823:Body Composition; D002097:C-Reactive Protein / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000401:mortality; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology; D016030:Kidney Transplantation / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000453:epidemiology*; D012709:Serum Albumin / Q000378:metabolism; D017211:Treatment Failure
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein