Risk factors associated with moderate-to-severe renal dysfunction among heart transplant patients: results from the CAPRI study.
The longer survival of patients with heart transplantation (HT) favors calcineurin inhibitor-related chronic kidney disease (CKD). It behoves to identify risk factors. At 14 Spanish centers, data on 1062 adult patients with HT (age 59.2 ± 12.3 yr, 82.5% men) were collected at routine follow-up examinations. Glomerular filtration rate, GFR, was estimated using the four-variable MDRD equation, and moderate-or-severe renal dysfunction (MSRD) was defined as K/DOQI stage 3 CKD or worse. Time since transplant ranged from one month to 22 yr (mean 6.7 yr). At assessment, 26.6% of patients were diabetic and 63.9% hypertensive; 53.9% were taking cyclosporine and 33.1% tacrolimus; and 61.4% had MSRD. Among patients on cyclosporine or tacrolimus at assessment, multivariate logistic regression identified male sex (OR 0.44), pre- and post-HT creatinine (2.73 and 3.13 per mg/dL), age at transplant (1.06 per yr), time since transplant (1.05 per yr), and tacrolimus (0.65) as independent positive or negative predictors of MSRD. It is concluded that female sex, pre- and one-month post-HT serum creatinine, age at transplant, time since transplant, and immunosuppression with cyclosporine rather than tacrolimus may all be risk factors for development of CKD ≥ stage 3 by patients with HT.
Delgado
Juan F
JF
Hospital Universitario 12 De Octubre, Madrid, Spain. jdelgado.hdoc@salud.madrid.org
Crespo-Leiro
María G
MG
Gómez-Sánchez
Miguel A
MA
Paniagua
María J
MJ
González-Vílchez
Francisco
F
Vázquez de Prada
José A
JA
Fernández-Yáñez
Juan
J
Pascual
David
D
Almenar
Luis
L
Martínez-Dolz
Luis
L
Díaz
Beatriz
B
Roig
Eulalia
E
Segovia
Javier
J
Arizón
Jose M
JM
Garrido
Iris
I
Blasco
Teresa
T
López
Javier
J
Brossa
Vicens
V
Manito
Nicolás
N
Muñiz
Javier
J
D000293:Adolescent; D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents; D003404:Creatinine