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. 2020 Dec 12;14(6):1665-1672.
doi: 10.1093/ckj/sfaa203. eCollection 2021 Jun.

Relationship between decline in estimated or measured glomerular filtration rate and 16-year postrenal transplant outcome

Agnes Delay  1 , Olivier Moranne  2   3 , Coraline Fafin  2 , Christophe Mariat  1 , Eric Alamartine  1 , Pierre Delanaye  4 , Nicolas Maillard  1
Affiliations

Relationship between decline in estimated or measured glomerular filtration rate and 16-year postrenal transplant outcome

Agnes Delay et al. Clin Kidney J. .

Abstract

Background: Glomerular filtration rate (GFR) decline ≥30% over 2 years can substitute for the conventional 'doubling of serum creatinine' to predict end-stage renal disease in patients with native kidneys. While chronic kidney disease trajectory is less predictable in transplanted patients, recent data have suggested that similar GFR decline might be an acceptable surrogate for long-term transplant outcome. We sought (i) to confirm the prognostic value of an early GFR decline in kidney transplant recipients and (ii) to determine whether using direct measurement of GFR with inulin improves the performance of this surrogate.

Methods: We retrospectively analysed all recipients transplanted between 1989 and 2000 in our centre, with inulin-measured and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-estimated GFR at 1 and 5 years post-transplant, and evaluated the performance [time-dependent area under the receiver operating characteristic curve (ROC AUC) and subdistribution hazard ratio (sdHR) with competing risk model] of GFR change to predict graft failure and all-cause mortality.

Results: Out of 417 kidney transplant recipients, 116 patients had lost their graft and 77 had died 16 years after transplantation. While being significantly associated with graft failure [sdHR = 2.37 (95% confidence interval 1.47-3.83)], CKD-EPI-GFR decline ≥30% failed to appropriately predict long-term graft survival (C-statistics of 0.63). Concordance between inulin-GFR and CKD-EPI-GFR to detect similar GFR change was only 53%. Inulin-GFR change was, however, not a better predictor (C-statistics of 0.59). Comparable results were observed for mortality.

Conclusions: Our data suggest that early GFR decline is a poor surrogate for long-term transplant outcome, even when change in GFR is directly measured by a reference method.

Keywords: CKD-EPI equation; glomerular filtration rate decline; inulin; kidney transplantation; prognosis.

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Figures

FIGURE 1:
FIGURE 1:
Flowchart detailing the exclusion and inclusion criteria for the creation of the population study cohort.
FIGURE 2:
FIGURE 2:
Cumulative incidence function curves of graft failure (A) and all-cause mortality (B) according to GFR decline, either estimated (red) or measured (blue) from 1 to 5 years post-transplant.
FIGURE 3:
FIGURE 3:
Subdistribution HR (and 95% CI) for graft failure and all-cause mortality according to GFR decline, either estimated (circle) or measured (diamond) from 1 to 5 years post-transplant.
See this image and copyright information in PMC

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