Progression of kidney disease in chronic renal transplant rejection

The rate of progression of renal insufficiency was quantitated from reciprocal of serum creatinine versus time plots in patients with clinical and histologic evidence of chronic renal transplant rejection. The plots were evaluated by the breakpoint test. This method identifies breakpoints in a linear plot and compares the statistical significance of the fit provided by two intersecting lines with that of a single straight line. The breakpoint test when applied to the 22 patients with a significant linear correlation between the reciprocal of serum creatinine versus time detected a change in the slope in 20 cases (90.9%) indicating the presence of a breakpoint. The average diastolic, systolic, and mean arterial pressures before the breakpoint were significantly correlated with the value of the serum creatinine at the time of the change of the slope (r = 0.45, P less than 0.05; r = 0.58, P less than 0.01; r = 0.56, P less than 0.05, respectively) demonstrating more severe hypertension in those patients with the more severe renal dysfunction. The slope after the breakpoint was significantly correlated with the mean diastolic blood pressure values after the breakpoint (r = 0.48, P less than 0.05) with higher pressures being found in those patients with faster rates of decline in renal function. Both before and after the breakpoint occurred, the rate of progression of the renal disease, as estimated by the reciprocal of serum creatinine versus time plot, was greater when the mean diastolic blood pressure was higher than 90 mmHg. In conclusion, the vast majority of patients with proven chronic rejection progress linearly although a change in the rate of progression was frequent. Higher levels of blood pressure correlate with greater rates of progression of renal insufficiency, and a faster progression associates with a diastolic blood pressure greater than 90 mmHg.