Calcification Propensity and Survival among Renal Transplant Recipients.
Calciprotein particle maturation time (T50) in serum is a novel measure of individual blood calcification propensity. To determine the clinical relevance of T50 in renal transplantation, baseline serum T50 was measured in a longitudinal cohort of 699 stable renal transplant recipients and the associations of T50 with mortality and graft failure were analyzed over a median follow-up of 3.1 years. Predictive value of T50 was assessed for patient survival with reference to traditional (Framingham) risk factors and the calcium-phosphate product. Serum magnesium, bicarbonate, albumin, and phosphate levels were the main determinants of T50, which was independent of renal function and dialysis vintage before transplant. During follow-up, 81 (12%) patients died, of which 38 (47%) died from cardiovascular causes. Furthermore, 45 (6%) patients developed graft failure. In fully adjusted models, lower T50 values were independently associated with increased all-cause mortality (hazard ratio, 1.43; 95% confidence interval, 1.11 to 1.85; P=0.006 per SD decrease) and increased cardiovascular mortality (hazard ratio, 1.55; 95% confidence interval, 1.04 to 2.29; P=0.03 per SD decrease). In addition to age, sex, and eGFR, T50 improved prognostication for all-cause mortality, whereas traditional risk factors or calcium-phosphate product did not. Lower T50 was also associated with increased graft failure risk. The associations of T50 with mortality and graft failure were confirmed in an independent replication cohort. In conclusion, reduced serum T50 was associated with increased risk of all-cause mortality, cardiovascular mortality, and graft failure and, of all tested parameters, displayed the strongest association with all-cause mortality in these transplant recipients.
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
Charlotte A
CA
Keyzer
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
Martin H
MH
de Borst
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Top Institute Food and Nutrition, Wageningen, The Netherlands;
Else
E
van den Berg
Helmholtz Institute for Biomedical Engineering, Biointerface Laboratory, Rheinisch-Westfälische Technische Hochschule, Aachen, Germany;
Willi
W
Jahnen-Dechent
Department of Nephrology, Hypertension and Clinical Pharmacology, University Hospital Bern (Inselspital), Bern, Switzerland;
Spyridon
S
Arampatzis
Department of Nephrology, Bürgerspital Solothurn, Solothurn, Switzerland;
Stefan
S
Farese
Department of Internal Medicine, Emmental Hospital, Burgdorf, Switzerland;
Ivo P
IP
Bergmann
Department of Nephrology, Rheinisch-Westfälische Technische Hochschule University of Aachen, Aachen, Germany;
Jürgen
J
Floege
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
Gerjan
G
Navis
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Top Institute Food and Nutrition, Wageningen, The Netherlands;
Stephan J L
SJ
Bakker
Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
Harry
H
van Goor
Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany; and.
Ute
U
Eisenberger
Department of Clinical Chemistry, University Hospital Bern (Inselspital), Bern, Switzerland andreas.pasch@insel.ch.
Andreas
A
Pasch
D002114:Calcinosis / Q000097:blood / Q000453:epidemiology / Q000401:mortality*; D002131:Calcium Pyrophosphate / Q000097:blood; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
D002131:Calcium Pyrophosphate
calcification propensity; calciprotein particles; graft failure; mortality risk; renal transplantation; serum T50