Worsening Post-Transplant CKD Predicts Higher Graft Failure Risk
PHILADELPHIA—Worsening of chronic kidney disease (CKD) stage in the first year following renal transplantation is associated with an increased risk of graft failure, researchers reported at Kidney Week.
The findings, from a study of 77,206 adult Medicare beneficiaries who received a kidney-only transplant, suggest that patient management strategies targeted at preserving renal function in the early post-transplant period will have a positive impact on graft survival, according to the investigators.
“Given the scarceness of donor organs, management strategies targeted at preserving renal function will have not only clinical implications but economic consequences as well,” said lead investigator William Irish, PhD, of CTI Clinical Trial and Consulting Services. “Furthermore, the results can be used to inform the design of a clinical trial where the primary objective is to preserve renal function.”
The study showed, for example, that renal transplant patients who progressed from CKD stage 3 at six months post-transplant to CKD stage 4 at 12 months had a 3.5 times increased risk of graft failure compared with patients who remained in CKD stage 3 at 12 months post-transplant, and a 53% graft survival rate versus 85% at four years, respectively. Patients who progressed from stage 3 to stage 5 from month 6 to month 12 had an 11.5 times increased risk of graft failure and 20% graft survival at four years compared to patients who remained in CKD stage 3 at 12 months post-transplant.
“Change in renal function in the early period post-transplantation is an important prognostic determinant of long-term graft survival,” Dr. Irish told Renal & Urology News. “These results provide further evidence that preserving renal function has a positive impact on the net benefit of kidney transplantation.”
For the study, Dr. Irish's team used estimated glomerular filtration rate (eGFR) thresholds (in mL/min/1.73 m2) established by the National Kidney Foundation definitions for CKD stage: stage 1, 90 or higher; 2, less than 90 but not less than 60; 3, less than 60 but not less than 30; 4, less than 30 but not less than 15; and 5, less than 15.