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Filtration Markers, Cardiovascular Disease, Mortality, and Kidney Outcomes in Stable Kidney Transplant Recipients:

M C Foster1, D E Weiner1, A G Bostom2

  • 1Division of Nephrology, Tufts Medical Center, Boston, MA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|March 4, 2017
PubMed

Insights

Cystatin C and beta-2-microglobulin (B2M) are better predictors of adverse outcomes like cardiovascular events, mortality, and kidney failure in kidney transplant recipients than creatinine. These filtration markers offer stronger prognostic value for transplant patient health.

Area of Science:

  • Nephrology
  • Transplantation Medicine
  • Cardiovascular Research

Background:

  • Cystatin C and beta-2-microglobulin (B2M) are established filtration markers linked to adverse outcomes in general populations.
  • Their predictive power may exceed that of creatinine, particularly in specific patient cohorts.
  • Kidney transplant recipients represent a population at high risk for cardiovascular events, mortality, and graft failure.

Purpose of the Study:

  • To evaluate the association of estimated glomerular filtration rate (eGFR) derived from cystatin C (eGFRcys) and B2M (eGFRB2M) with cardiovascular outcomes, mortality, and kidney failure.
  • To compare the prognostic utility of eGFRcys and eGFRB2M against traditional creatinine-based eGFR (eGFRcr) in stable kidney transplant recipients.
  • To determine if these associations persist after adjusting for baseline eGFRcr.

Main Methods:

  • A case-cohort study design was employed within the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial.
  • A random subcohort (N=508) was selected and enriched for cardiovascular events, mortality, and kidney failure.
  • Multivariable regression models were used to assess hazard ratios for adverse outcomes based on eGFR categories (<30 vs. 60+ mL/min/1.73m2).

Main Results:

  • Lower eGFRcys (<30) was associated with significantly increased risk for cardiovascular events (HR 2.02), mortality (HR 3.92), and kidney failure (HR 9.49) compared to eGFRcys 60+.
  • Similarly, lower eGFRB2M (<30) showed strong associations with cardiovascular events (HR 2.56), mortality (HR 4.09), and kidney failure (HR 15.53).
  • These associations remained significant even after adjusting for baseline eGFRcr, indicating independent prognostic value.

Conclusions:

  • Cystatin C and B2M-based eGFR are strongly associated with adverse cardiovascular outcomes, mortality, and kidney failure in stable kidney transplant recipients.
  • These markers demonstrate superior or complementary prognostic capability compared to creatinine-based eGFR in this high-risk population.
  • Incorporating cystatin C and B2M into risk assessment may improve management strategies for kidney transplant recipients.

Keywords:
biomarkerclinical research/practiceglomerular filtration rate (GFR)kidney (native) function/dysfunctionkidney transplantation/nephrology

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