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

被引：22

作者：

Foster, M. C. ^{[1
]}

Weiner, D. E. ^{[1
]}

Bostom, A. G. ^{[2
]}

Carpenter, M. A. ^{[3
]}

Inker, L. A. ^{[1
]}

Jarolim, P. ^{[4
]}

Joseph, A. A. ^{[1
]}

Kusek, J. W. ^{[5
]}

Pesavento, T. ^{[6
]}

Pfeffer, M. A. ^{[7
]}

Rao, M. ^{[1
]}

Solomon, S. D. ^{[7
]}

Levey, A. S. ^{[1
]}

机构：

[1] Tufts Med Ctr, Div Nephrol, Boston, MA 02111 USA

[2] Rhode Isl Hosp, Providence, RI USA

[3] Univ N Carolina, Dept Biostat, Chapel Hill, NC USA

[4] Harvard Med Sch, Brigham & Womens Hosp, Dept Pathol, Boston, MA USA

[5] NIDDKD, Bethesda, MD USA

[6] Ohio State Univ, Med Ctr, Columbus, OH 43210 USA

[7] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Boston, MA USA

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2017年 / 17卷 / 09期

关键词：

RISK POPULATION COHORTS; NON-GFR DETERMINANTS; BETA-TRACE PROTEIN; CYSTATIN-C LEVELS; RENAL-TRANSPLANTATION; COLLABORATIVE METAANALYSIS; SERUM CREATININE; HIGHER ALBUMINURIA; ALL-CAUSE; GENERAL-POPULATION;

D O I：

10.1111/ajt.14258

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

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 (eGFR(cys)), B2M (eGFR(B2M)), and creatinine (eGFR(cr)) 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 eGFR(cr), eGFR(cys), and eGFRB2M were 46.0, 43.8, and 48.8 mL/min/1.73m(2), respectively. After multivariable adjustment, hazard ratios for eGFR(cys) and eGFRB2M < 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 eGFR(cr). We conclude that cystatin C and B2M are strongly associated with cardiovascular events, mortality, and kidney failure in stable kidney transplant recipients.

引用

页码：2390 / 2399

页数：10

共 46 条

[21] Predicting Coronary Heart Disease after Kidney Transplantation: Patient Outcomes in Renal Transplantation (PORT) Study [J].