The relationship between kidney function and long-term graft survival after kidney transplant

Bertram L. Kasiske; Ajay K. Israni; Jon J. Snyder; Melissa A. Skeans

doi:10.1053/j.ajkd.2010.10.054

The relationship between kidney function and long-term graft survival after kidney transplant

Bertram L. Kasiske, Ajay K. Israni, Jon J. Snyder, Melissa A. Skeans

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Abstract

Background: Whether chronic kidney disease (CKD) staging provides a useful framework for predicting outcomes after kidney transplant is unclear. Study Design: Retrospective cohort study. Setting & Participants: We used data from the Patient Outcomes in Renal Transplantation (PORT) Study, including 13,671 transplants from 12 centers during 10 years of follow-up. Predictor: Estimated glomerular filtration rate (eGFR; in milliliters per minute per 1.73 m²) at 12 months posttransplant. Outcomes: All-cause graft failure (a composite end point consisting of return to dialysis therapy, pre-emptive retransplant, or death with function), death-censored graft failure, and death with a functioning graft. Measurements: The relationship between 12-month eGFR and subsequent graft outcomes through 10 years posttransplant was assessed using Cox proportional hazards analyses. Results: Stage 3 included 63% of patients and was subdivided into stages 3a (eGFR, 45-59 mL/min/1.73 m²; 34%) and 3b (eGFR, 30-44 mL/min/1.73 m²; 29%). Compared with stage 2 (eGFR, 60-89 mL/min/1.73 m²; 24%), adjusted Cox proportional HRs for graft failure were 1.12 (95% CI, 1.01-1.24; P = 0.04) for stage 3a, 1.50 (95% CI, 1.35-1.66; P < 0.001) for stage 3b, 2.86 (95% CI, 2.53-3.22; P < 0.001) for stage 4 (eGFR, 15-29 mL/min/1.73 m²; 9%), and 13.2 (95% CI, 10.7-16.4; P < 0.001) for stage 5 (eGFR <15 mL/min/1.73 m²; 1%). For stage 1 (eGFR <90 mL/min/1.73 m²; 3%), risk of graft failure was increased (1.41 [95% CI, 1.13-1.75]; P < 0.001), likely due to serum creatinine associations independent of kidney function. Similar associations were seen between CKD stages and mortality. Limitations: Retrospective study; lack of gold-standard measurements of true GFR; lack of measures of comorbidity, inflammation, muscle mass, proteinuria, and other noncreatinine markers of eGFR. Conclusions: CKD stages validated in the general population provide a useful framework for predicting outcomes after kidney transplant.

Original language	English (US)
Pages (from-to)	466-475
Number of pages	10
Journal	American Journal of Kidney Diseases
Volume	57
Issue number	3
DOIs	https://doi.org/10.1053/j.ajkd.2010.10.054
State	Published - Mar 2011

Bibliographical note

Funding Information:
Support: This work was supported by a grant from Bristol-Myers Squibb Company , Plainsboro, NJ. The interpretation and reporting of these data are the responsibility of the authors. Dr Israni is a Robert Wood Johnson Foundation Faculty Scholar.

Keywords

Chronic kidney disease
estimated glomerular filtration rate
graft outcomes
kidney transplant

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1053/j.ajkd.2010.10.054

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@article{d8da4878f7404529a5087ca82052dcbd,

title = "The relationship between kidney function and long-term graft survival after kidney transplant",

abstract = "Background: Whether chronic kidney disease (CKD) staging provides a useful framework for predicting outcomes after kidney transplant is unclear. Study Design: Retrospective cohort study. Setting & Participants: We used data from the Patient Outcomes in Renal Transplantation (PORT) Study, including 13,671 transplants from 12 centers during 10 years of follow-up. Predictor: Estimated glomerular filtration rate (eGFR; in milliliters per minute per 1.73 m2) at 12 months posttransplant. Outcomes: All-cause graft failure (a composite end point consisting of return to dialysis therapy, pre-emptive retransplant, or death with function), death-censored graft failure, and death with a functioning graft. Measurements: The relationship between 12-month eGFR and subsequent graft outcomes through 10 years posttransplant was assessed using Cox proportional hazards analyses. Results: Stage 3 included 63% of patients and was subdivided into stages 3a (eGFR, 45-59 mL/min/1.73 m2; 34%) and 3b (eGFR, 30-44 mL/min/1.73 m2; 29%). Compared with stage 2 (eGFR, 60-89 mL/min/1.73 m2; 24%), adjusted Cox proportional HRs for graft failure were 1.12 (95% CI, 1.01-1.24; P = 0.04) for stage 3a, 1.50 (95% CI, 1.35-1.66; P < 0.001) for stage 3b, 2.86 (95% CI, 2.53-3.22; P < 0.001) for stage 4 (eGFR, 15-29 mL/min/1.73 m2; 9%), and 13.2 (95% CI, 10.7-16.4; P < 0.001) for stage 5 (eGFR <15 mL/min/1.73 m2; 1%). For stage 1 (eGFR <90 mL/min/1.73 m2; 3%), risk of graft failure was increased (1.41 [95% CI, 1.13-1.75]; P < 0.001), likely due to serum creatinine associations independent of kidney function. Similar associations were seen between CKD stages and mortality. Limitations: Retrospective study; lack of gold-standard measurements of true GFR; lack of measures of comorbidity, inflammation, muscle mass, proteinuria, and other noncreatinine markers of eGFR. Conclusions: CKD stages validated in the general population provide a useful framework for predicting outcomes after kidney transplant.",

keywords = "Chronic kidney disease, estimated glomerular filtration rate, graft outcomes, kidney transplant",

author = "Kasiske, {Bertram L.} and Israni, {Ajay K.} and Snyder, {Jon J.} and Skeans, {Melissa A.}",

note = "Funding Information: Support: This work was supported by a grant from Bristol-Myers Squibb Company , Plainsboro, NJ. The interpretation and reporting of these data are the responsibility of the authors. Dr Israni is a Robert Wood Johnson Foundation Faculty Scholar. ",

year = "2011",

month = mar,

doi = "10.1053/j.ajkd.2010.10.054",

language = "English (US)",

volume = "57",

pages = "466--475",

journal = "American Journal of Kidney Diseases",

issn = "0272-6386",

publisher = "W.B. Saunders Ltd",

number = "3",

}

TY - JOUR

T1 - The relationship between kidney function and long-term graft survival after kidney transplant

AU - Kasiske, Bertram L.

AU - Israni, Ajay K.

AU - Snyder, Jon J.

AU - Skeans, Melissa A.

N1 - Funding Information: Support: This work was supported by a grant from Bristol-Myers Squibb Company , Plainsboro, NJ. The interpretation and reporting of these data are the responsibility of the authors. Dr Israni is a Robert Wood Johnson Foundation Faculty Scholar.

PY - 2011/3

Y1 - 2011/3

N2 - Background: Whether chronic kidney disease (CKD) staging provides a useful framework for predicting outcomes after kidney transplant is unclear. Study Design: Retrospective cohort study. Setting & Participants: We used data from the Patient Outcomes in Renal Transplantation (PORT) Study, including 13,671 transplants from 12 centers during 10 years of follow-up. Predictor: Estimated glomerular filtration rate (eGFR; in milliliters per minute per 1.73 m2) at 12 months posttransplant. Outcomes: All-cause graft failure (a composite end point consisting of return to dialysis therapy, pre-emptive retransplant, or death with function), death-censored graft failure, and death with a functioning graft. Measurements: The relationship between 12-month eGFR and subsequent graft outcomes through 10 years posttransplant was assessed using Cox proportional hazards analyses. Results: Stage 3 included 63% of patients and was subdivided into stages 3a (eGFR, 45-59 mL/min/1.73 m2; 34%) and 3b (eGFR, 30-44 mL/min/1.73 m2; 29%). Compared with stage 2 (eGFR, 60-89 mL/min/1.73 m2; 24%), adjusted Cox proportional HRs for graft failure were 1.12 (95% CI, 1.01-1.24; P = 0.04) for stage 3a, 1.50 (95% CI, 1.35-1.66; P < 0.001) for stage 3b, 2.86 (95% CI, 2.53-3.22; P < 0.001) for stage 4 (eGFR, 15-29 mL/min/1.73 m2; 9%), and 13.2 (95% CI, 10.7-16.4; P < 0.001) for stage 5 (eGFR <15 mL/min/1.73 m2; 1%). For stage 1 (eGFR <90 mL/min/1.73 m2; 3%), risk of graft failure was increased (1.41 [95% CI, 1.13-1.75]; P < 0.001), likely due to serum creatinine associations independent of kidney function. Similar associations were seen between CKD stages and mortality. Limitations: Retrospective study; lack of gold-standard measurements of true GFR; lack of measures of comorbidity, inflammation, muscle mass, proteinuria, and other noncreatinine markers of eGFR. Conclusions: CKD stages validated in the general population provide a useful framework for predicting outcomes after kidney transplant.

AB - Background: Whether chronic kidney disease (CKD) staging provides a useful framework for predicting outcomes after kidney transplant is unclear. Study Design: Retrospective cohort study. Setting & Participants: We used data from the Patient Outcomes in Renal Transplantation (PORT) Study, including 13,671 transplants from 12 centers during 10 years of follow-up. Predictor: Estimated glomerular filtration rate (eGFR; in milliliters per minute per 1.73 m2) at 12 months posttransplant. Outcomes: All-cause graft failure (a composite end point consisting of return to dialysis therapy, pre-emptive retransplant, or death with function), death-censored graft failure, and death with a functioning graft. Measurements: The relationship between 12-month eGFR and subsequent graft outcomes through 10 years posttransplant was assessed using Cox proportional hazards analyses. Results: Stage 3 included 63% of patients and was subdivided into stages 3a (eGFR, 45-59 mL/min/1.73 m2; 34%) and 3b (eGFR, 30-44 mL/min/1.73 m2; 29%). Compared with stage 2 (eGFR, 60-89 mL/min/1.73 m2; 24%), adjusted Cox proportional HRs for graft failure were 1.12 (95% CI, 1.01-1.24; P = 0.04) for stage 3a, 1.50 (95% CI, 1.35-1.66; P < 0.001) for stage 3b, 2.86 (95% CI, 2.53-3.22; P < 0.001) for stage 4 (eGFR, 15-29 mL/min/1.73 m2; 9%), and 13.2 (95% CI, 10.7-16.4; P < 0.001) for stage 5 (eGFR <15 mL/min/1.73 m2; 1%). For stage 1 (eGFR <90 mL/min/1.73 m2; 3%), risk of graft failure was increased (1.41 [95% CI, 1.13-1.75]; P < 0.001), likely due to serum creatinine associations independent of kidney function. Similar associations were seen between CKD stages and mortality. Limitations: Retrospective study; lack of gold-standard measurements of true GFR; lack of measures of comorbidity, inflammation, muscle mass, proteinuria, and other noncreatinine markers of eGFR. Conclusions: CKD stages validated in the general population provide a useful framework for predicting outcomes after kidney transplant.

KW - Chronic kidney disease

KW - estimated glomerular filtration rate

KW - graft outcomes

KW - kidney transplant

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The relationship between kidney function and long-term graft survival after kidney transplant

Abstract

Bibliographical note

Keywords

UN SDGs

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