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Prognostic value for long-term graft survival of estimated glomerular filtration rate and proteinuria quantified at 3 months after kidney transplantation

Authors
  • Blancho, Gilles
  • Branchereau, Julien
  • Cantarovich, Diego
  • Chapelet, Agnès
  • Dantal, Jacques
  • Deltombe, Clément
  • Figueres, Lucile
  • Garandeau, Claire
  • Gourraud-Vercel, Caroline
  • Hourmant, Maryvonne
  • Karam, Georges
  • Kerleau, Clarisse
  • Meurette, Aurélie
  • Ville, Simon
  • Kandell, Christine
  • Moreau, Anne
  • Renaudin, Karine
  • Cesbron, Anne
  • Delbos, Florent
  • Walencik, Alexandre
  • And 31 more
Type
Published Article
Journal
Clinical Kidney Journal
Publisher
Oxford University Press
Publication Date
Apr 26, 2020
Volume
13
Issue
5
Pages
791–802
Identifiers
DOI: 10.1093/ckj/sfaa044
PMID: 33125000
PMCID: PMC7577768
Source
PubMed Central
Keywords
License
Unknown

Abstract

Background The estimated glomerular filtration rate (eGFR) measured at 1 year is the usual benchmark applied in kidney transplantation (KT). However, acting on earlier eGFR values could help in managing KT during the first post-operative year. We aimed to assess the prognostic value for long-term graft survival of the early (3 months) quantification of eGFR and proteinuria following KT. Methods The 3-, 6- and 12-month eGFR using the Modified Diet in Renal Disease equation (eGFRMDRD) was determined and proteinuria was measured in 754 patients who underwent their first KT between 2000 and 2010 (with a mean follow-up of 8.3 years) in our centre. Adjusted associations with graft survival were estimated using a multivariable Cox model. The predictive accuracy was estimated using the C-index and net reclassification index. These same analyses were measured in a multicentre validation cohort of 1936 patients. Results Both 3-month eGFRMDRD and proteinuria were independent predictors of return to dialysis (all P < 0.05) and there was a strong correlation between eGFR at 3 and 12 months (Spearman’s ρ = 0.76). The predictive accuracy of the 3-month eGFR was within a similar range and did not differ significantly from the 12-month eGFR in either the derivation cohort [C-index 62.6 (range 57.2–68.1) versus 66.0 (range 60.1–71.9), P = 0.41] or the validation cohort [C-index 69.3 (range 66.4–72.1) versus 71.7 (range 68.7–74.6), P = 0.25]. Conclusion The 3-month eGFR was a valuable predictor of the long-term return to dialysis whose predictive accuracy was not significantly less than that of the 12-month eGFR in multicentre cohorts totalling >2500 patients. Three-month outcomes may be useful in randomized controlled trials targeting early therapeutic interventions.

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