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Chronic kidney disease in renal transplant recipients
R Marcén1, J Pascual, M Tenorio
1Servicios de Nefrología y Urología, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. rmarcen.hrc@salud.madrid.org
Insights
Chronic kidney disease (CKD) affects over 60% of renal transplant recipients. Estimated glomerular filtration rate (GFR) is a key predictor of long-term graft survival and aids in risk stratification for improved patient outcomes.
Area of Science:
- Nephrology
- Transplantation Medicine
- Chronic Kidney Disease (CKD) Research
Background:
- Chronic kidney disease (CKD) diagnosis and staging are crucial for managing renal transplant patients.
- The Kidney Disease Outcomes Quality Initiative (K/DOQI) provides guidelines for CKD classification based on estimated glomerular filtration rate (GFR).
Purpose of the Study:
- To evaluate the applicability of K/DOQI guidelines for diagnosing and classifying CKD in renal transplant recipients.
- To assess the relationship between CKD stages and graft survival post-renal transplantation.
Main Methods:
- Analysis of 447 cadaveric kidney transplants with graft function at 12 months.
- GFR calculated using the MDRD equation; patients categorized into CKD stages.
- Graft survival and complication prevalence analyzed in relation to GFR and CKD stage.
Main Results:
- Over 60% of renal transplant recipients exhibited CKD.
- A significant association was found between lower GFR and reduced 10-year graft survival.
- Complications like anemia and hypertension increased with declining GFR.
Conclusions:
- The K/DOQI CKD classification is useful for identifying high-risk renal transplant patients.
- GFR serves as a significant predictor of long-term graft survival.
- CKD staging can inform strategies to enhance transplant outcomes.
Unlabelled:
The aim of the present study was to investigate the utility in renal transplant patients of the guidelines for the diagnosis and classification of chronic kidney disease (CKD) based on the estimated glomerular filtration rate (GFR) elaborated by the Kidney Disease Outcomes Quality Initiative (K/DOQI) of the National Kidney Foundation.
Patients And Methods:
Four hundred forty-seven cadaveric kidney transplants performed between 1980 and 1994 with graft function at 12 months were included in the study. The GFR was calculated according to the MDRD equation.
Results:
The mean GFR at 12 months was 54.5 +/- 20.3 mL/min/1.73 m(2): 23 patients (5.1%) had a GFR > or =90 mL/min/1.73 m(2); 136 patients (30.6%), 60-89; 246 (54.7%), 30-59; 35 patients (7.8%), 15-29; and 7 patients (1.6%), GFR <15. Similar distribution of CKD stages was observed at 5 and 10 years. Unadjusted graft survival at 10 years was better among patients with a higher GFR at 12 months: 87% in patients with GFR >90 mL/min/1.73 m(2); 83% of GFR 60-89 mL/min/1.73 m(2); 63%, GFR 30-59 mL/min/1.73 m(2); and 23%, GFR <30 mL/min/1.73 m(2) (P < .001). The association between GFR and graft survival persisted when adjusted by the age and gender of the recipients and donors, time on dialysis, body mass index, immunosuppression, delayed graft function, rejection, and HLA mismatches. The prevalence of complications, such as anemia, hypertension, dyslipidemias, and number of drugs increased as GFR declined.
Conclusions:
More than 60% of recipients presented chronic kidney disease. GFR was a predictive factor for graft survival at 10 years. The classification of renal transplant patients by CKD stages may help to identify patients with increased risk of graft loss and also to design strategies to improve outcomes.
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