title: High-grade proteinuria as a cardiovascular risk factor in renal transplant recipients.
abstract: BACKGROUND
  Proteinuria is a marker of graft damage and is closely associated with a higher risk of morbidity, mortality, and cardiovascular disease in kidney transplant recipients (KTRs). Arterial stiffness is a well-known predictor of vascular calcification and systemic arteriosclerosis. In our study, we aimed to investigate the association between proteinuria and graft/patient survival and to determine whether proteinuria may be a predictor for cardiovascular disease in our KTR population.
  
  
  METHODS
  Ninety KTRs (31 women; age, 38.7 ± 11 years, with 45.9 ± 9.6 months post-transplantation period) with normal graft functions in the 3 to 5 years of the post-transplantation period were enrolled. All patients were evaluated for their standard clinical (age, sex, and duration of hemodialysis) parameters. High-grade proteinuria was defined as proteinuria >500 mg/day in the 24-hour urine collection. All patients were evaluated by means of pulse-wave velocity (PWV) measurement at the initiation of the study.
  
  
  RESULTS
  Patients were divided into 2 groups: group 1 (high-grade proteinuria) patients with ≥500 mg/24 hours (n = 30) and group 2 (low-grade proteinuria) patients with <500 mg/24 hours (n = 60). High-grade proteinuria was correlated with higher PWV measurements and lower estimated glomerular filtration levels. Proteinuria appears to precede the elevation of serum creatinine and thus may be a useful marker of renal injury and may also be a contributing factor on deterioration of the graft.
  
  
  CONCLUSIONS
  High-grade (>500 mg/day) proteinuria in KTRs is strongly associated with poor graft survival and increased risk of cardiovascular events. In our study, we proved the significant difference between high-grade and low-grade proteinuric patients, and we suggest 500 mg/day as the threshold of proteinuria in KTR population.
authors.affiliation: Department of Nephrology, Baskent University, Ankara, Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Guliyev
authors.affiliation: Department of Nephrology, Baskent University, Ankara, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Sayin
authors.affiliation: Department of Nephrology, Baskent University, Ankara, Turkey. Electronic address: mehtap94@yahoo.com.
authors.forename: M E
authors.initials: ME
authors.lastname: Uyar
authors.affiliation: Department of Nephrology, Baskent University, Ankara, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Genctoy
authors.affiliation: Department of Nephrology, Baskent University, Ankara, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Sezer
authors.affiliation: Department of Nephrology, Baskent University, Ankara, Turkey.
authors.forename: Z
authors.initials: Z
authors.lastname: Bal
authors.affiliation: Department of Nephrology, Baskent University, Ankara, Turkey.
authors.forename: B G
authors.initials: BG
authors.lastname: Demirci
authors.affiliation: Department of General Surgery, Baskent University, Ankara, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D011507:Proteinuria / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D066027:Transplant Recipients; D014421:Turkey / Q000453:epidemiology