Filtration Markers, Cardiovascular Disease, Mortality, and Kidney Outcomes in Stable Kidney Transplant Recipients: The FAVORIT Trial. Issue 9 (30th March 2017)

• Record Type: Journal Article
• Authors: Foster, M. C.; Weiner, D. E.; Bostom, A. G.; Carpenter, M. A.; Inker, L. A.; Jarolim, P.; Joseph, A. A.; Kusek, J. W.; Pesavento, T.; Pfeffer, M. A.; Rao, M.; Solomon, S. D.; Levey, A. S.
• Is Part Of: American journal of transplantation. Volume 17:Issue 9(2017)
• Page Start: 2390
• Page End: 2399
• Publication Date: 2017-03-30
• Subjects: clinical research/practice -- kidney transplantation/nephrology -- biomarker -- glomerular filtration rate (GFR) -- kidney (native) function/dysfunction; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.14258
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Cystatin C and beta‐2‐microglobulin (B2M) are filtration markers associated with adverse outcomes in nontransplant populations, sometimes with stronger associations than for creatinine. We evaluated associations of estimated glomerular filtration rate from cystatin C (eGFRcys ), B2M (eGFRB 2M ), and creatinine (eGFRcr ) with cardiovascular outcomes, mortality, and kidney failure in stable kidney transplant recipients using a case–cohort study nested within the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial. A random subcohort was selected (N = 508; mean age 51.6 years, median transplant vintage 4 years, 38% women, 23.6% nonwhite race) with enrichment for cardiovascular events (N = 306; 54 within the subcohort), mortality (N = 208; 68 within the subcohort), and kidney failure (N = 208; 52 within the subcohort). Mean eGFRcr, eGFRcys, and eGFRB 2M were 46.0, 43.8, and 48.8 mL/min/1.73m 2, respectively. After multivariable adjustment, hazard ratios for eGFRcys and eGFRB 2M <30 versus 60+ were 2.02 (95% confidence interval [CI] 1.09–3.76; p = 0.03) and 2.56 (1.35–4.88; p = 0.004) for cardiovascular events; 3.92 (2.11–7.31) and 4.09 (2.21–7.54; both p < 0.001) for mortality; and 9.49 (4.28–21.00) and 15.53 (6.99–34.51; both p < 0.001) for kidney failure. Associations persisted with additional adjustment for baseline eGFRcr . We conclude that cystatin C and B2M are strongly associated with cardiovascular events, mortality, and kidney failure in stable kidney transplant recipients. Abstract : The authors find an association between a lower baseline estimated glomerular filtration rate (GFR) using the markers cystatin C and beta‐2‐microglobulin and a higher risk of all‐cause and cardiovascular mortality and kidney failure during follow‐up, independent of baseline estimated GFR using creatinine.