title: Impact of Early Low-Grade Proteinuria and Allograft Dysfunction on Survival in Expanded Criteria Donor Kidney Transplant Recipients.
abstract: BACKGROUND
  Recent studies have demonstrated a relationship between low-grade proteinuria and worse graft survival, but this has not been fully studied in expanded criteria donor (ECD) kidney transplant recipients.
  
  
  OBJECTIVE
  The aim of this study was to assess whether the combination of early low-grade proteinuria (<1 g/d) and allograft dysfunction at the third month post-transplantation predicts outcomes in terms of survival in ECD kidney transplant recipients.
  
  
  METHODS
  We studied a cohort of 269 ECD kidney transplant recipients subdivided into 4 groups according to clinically relevant proteinuria (300 mg/d) and median creatinine (Cr; 1.7 mg/dL; interquartile range, 1.4-2.1 mg/dL) at the third month post-transplantation: Group A (Cr <1.7 mg/dL and proteinuria <300 mg/24 h; n = 97), Group B (Cr <1.7 mg/dL and proteinuria ≥300 mg/24 h; n = 38), Group C (Cr ≥1.7 mg/dL and proteinuria <300 mg/24 h; n = 79), and Group D (Cr ≥1.7 mg/dL and proteinuria ≥300 mg/24 h; n = 55).
  
  
  RESULTS
  Death-censored graft survival was significantly lower in Group D compared with the rest (P < .007). Multivariate Cox regression analysis using fixed covariates showed that the combination of low-grade proteinuria and a lower estimated glomerular filtration rate (eGFR) as associated with graft failure (hazard rate [HR] 2.5, 95% confidence interval [CI], 1.09-5.97; P = .03).
  
  
  CONCLUSIONS
  The early association of low-grade proteinuria and allograft dysfunction represents an important risk factor for graft loss in ECD kidney transplant recipients. Strategies to optimize renal function could improve the outcome in this specific population.
authors.affiliation: Nephrology Department, Regional University Hospital of Malaga, Malaga Institute of Biomedical Research (IBIMA), University of Malaga, Malaga, Spain. Electronic address: verolopezjim@yahoo.es.
authors.forename: V
authors.initials: V
authors.lastname: López
authors.affiliation: Nephrology Department, Regional University Hospital of Malaga, Malaga Institute of Biomedical Research (IBIMA), University of Malaga, Malaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Cabello
authors.affiliation: Nephrology Department, Regional University Hospital of Malaga, Malaga Institute of Biomedical Research (IBIMA), University of Malaga, Malaga, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Ruíz-Esteban
authors.affiliation: Nephrology Department, Regional University Hospital of Malaga, Malaga Institute of Biomedical Research (IBIMA), University of Malaga, Malaga, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Sola
authors.affiliation: Nephrology Department, Regional University Hospital of Malaga, Malaga Institute of Biomedical Research (IBIMA), University of Malaga, Malaga, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Gutiérrez
authors.affiliation: Nephrology Department, Regional University Hospital of Malaga, Malaga Institute of Biomedical Research (IBIMA), University of Malaga, Malaga, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Jironda
authors.affiliation: Nephrology Department, Regional University Hospital of Malaga, Malaga Institute of Biomedical Research (IBIMA), University of Malaga, Malaga, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Burgos
authors.affiliation: Nephrology Department, Regional University Hospital of Malaga, Malaga Institute of Biomedical Research (IBIMA), University of Malaga, Malaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: González-Molina
authors.affiliation: Nephrology Department, Regional University Hospital of Malaga, Malaga Institute of Biomedical Research (IBIMA), University of Malaga, Malaga, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Hernández
mesh_terms: D064591:Allografts; D003404:Creatinine / Q000378:metabolism; D051799:Delayed Graft Function / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000175:diagnosis / Q000209:etiology*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014019:Tissue Donors; D066027:Transplant Recipients
chemical_list: D003404:Creatinine