Temporal changes of proteinuria after kidney transplantation: association with cardiovascular morbidity and mortality

Molcho, Maya; Rozen‐Zvi, Benaya; Shteinmats, Tali; Dor, Naomi Ben; Vahav, Itay; Nesher, Eviatar; Rahamimov, Ruth

doi:10.1007/s40620-020-00703-6

Cited by 4 publications

(5 citation statements)

References 30 publications

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“…Mottola C. et al also showed a strong correlation between proteinuria and poor graft survival but measured only within 1 year of Ktx [ 20 ]. Proteinuria is also a risk factor for death in the first post-transplant year [ 10 ] and cardiovascular diseases in KTRs [ 21 ]. Moreover, there is the association between proteinuria and the recurrence of primary glomerulonephritis [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Salivary Indoxyl Sulfate with Proteinuria for Predicting Graft Deterioration in Kidney Transplant Recipients

Korytowska

Wyczalkowska-Tomasik

Pączek

et al. 2021

Toxins

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Acute kidney injury (AKI) is a significant risk factor for developing chronic kidney disease and progression to end-stage renal disease in elderly patients. AKI is also a relatively common complication after kidney transplantation (KTx) associated with graft failure. Since the lifespan of a transplanted kidney is limited, the risk of the loss/deterioration of graft function (DoGF) should be estimated to apply the preventive treatment. The collection of saliva and urine is more convenient than collecting blood and can be performed at home. The study aimed to verify whether non-invasive biomarkers, determined in saliva and urine, may be useful in the prediction of DoGF in kidney transplant recipients (KTRs) (n = 92). Salivary and serum toxins (p-cresol sulfate, pCS; indoxyl sulfate, IS) concentrations were determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Urinary proteins, hemoglobin, and glucose were measured using a semi-quantitative strip test. Salivary IS (odds ratio (OR) = 1.19), and proteinuria (OR = 3.69) were demonstrated as independent factors for the prediction of DoGF. Satisfactory discriminatory power (area under the receiver operating characteristic curve (AUC) = 0.71 ± 0.07) and calibration of the model were obtained. The model showed that categories of the increasing probability of the risk of DoGF are associated with the decreased risk of graft survival. The non-invasive diagnostic biomarkers are a useful screening tool to identify high-risk patients for DoGF.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Salivary Indoxyl Sulfate with Proteinuria for Predicting Graft Deterioration in Kidney Transplant Recipients

Korytowska

Wyczalkowska-Tomasik

Pączek

et al. 2021

Toxins

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“…Unfortunately, serial GFR evaluations were no available for our cohort. However, a recently published evaluation of the effect of time dependent proteinuria on CVD found no independent association between serial GFR measurements and MACE (10).…”

Section: Discussionmentioning

confidence: 91%

“…Even though they did not reach statistical significance, probably due to short follow-up, they raised awareness to the rising risk in this special population (9). A similar project published this year form our institute exemplifies the importance of controlling proteinuria to reduce CVD risk (10).…”

Section: Discussionmentioning

confidence: 98%

“…Weiner et al showed that microalbuminuria, as evaluated by albumin creatinine ratio (ACR), had a non-significant trend for association with increased risk of CVD in patients after kidney transplantation (9). An analysis from our institute showed proteinuria, using urine dipstick, was significantly associated with an increased risk of major cardiovascular adverse events (MACE) (10). However, this association was not evaluated by the gold standard of timed urine collection.…”

Section: Introductionmentioning

confidence: 93%

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Microalbuminuria After Kidney Transplantation Predicts Cardiovascular Morbidity

et al. 2021

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Background: Microalbuminuria is a well-characterized marker of kidney malfunction, both in diabetic and non-diabetic populations, and is used as a prognostic marker for cardiovascular morbidity and mortality. A few studies implied that it has the same value in kidney transplanted patients, but the information relies on spot or dipstick urine protein evaluations, rather than the gold standard of timed urine collection.Methods: We revisited a cohort of 286 kidney transplanted patients, several years after completing a meticulously timed urine collection and assessed the prevalence of major cardiovascular adverse events (MACE) in relation to albuminuria.Results: During a median follow up of 8.3 years (IQR 6.4–9.1) 144 outcome events occurred in 101 patients. By Kaplan-Meier analysis microalbuminuria was associated with increased rate of CV outcome or death (p = 0.03), and this was still significant after stratification according to propensity score quartiles (p = 0.048). Time dependent Cox proportional hazard analysis showed independent association between microalbuminuria and CV outcomes 2 years following microalbuminuria detection (HR 1.83, 95% CI 1.07–2.96).Conclusions: Two years after documenting microalbuminuria in kidney transplanted patients, their CVD risk was increased. There is need for primary prevention strategies in this population and future studies should address the topic.

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“…Proteinuria is an indicator of kidney function and, when present, it is associated with a higher incidence of acute rejection, hypertension, graft dysfunction, cardiovascular risk, and long-term mortality [ 3 , 4 ]. This clinical condition may be due to several factors, such as the nephrotoxicity of immunosuppressive therapy, recurrent glomerulonephritis, glomerulopathies, ischemic damage from surgery, diabetic or hypertensive nephropathy, presence of native kidneys, and other indirect factors such as high sodium and protein intakes in the diet [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of an individualized nutritional intervention on kidney function, body composition, and quality of life in kidney transplant recipients: Study protocol for a randomized clinical trial

et al. 2022

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Background Proteinuria after kidney transplantation (KTx) has been a frequent problem due to several factors, high protein intake being one of them. Individualized nutritional intervention in the late post-KTx period can promote the improvement or the reduction of risks associated with the parameters of evaluation of kidney function, body composition, and quality of life in individuals submitted to KTx. Methods This is a single-center, randomized and stratified clinical trial. The study will be conducted in a university hospital in northeastern Brazil with 174 individuals aged ≥19 years submitted to KTx and followed up for 12 months. Assessments will take place at 3-month intervals (T0, T3, T6, T9, and T12). The patients will be allocated to intervention and control groups by random allocation. The intervention group will receive individualized nutritional interventions with normoproteic diets (1.0 g/kg) after 60 days of KTx whereas the controls will receive the standard nutritional guidance for the post-KTx period. The primary efficacy variable is the change from baseline in log proteinuria assessed with the urinary albumin/creatinine ratio. Secondary efficacy variables include body composition, anthropometry, quality of life assessment and physical activity, lipid profile and glycemic control. Ninety-two subjects per group will afford 70% power to detect a difference of 25% between groups in log proteinuria. Primary efficacy analysis will be on the modified intention-to-treat population with between-groups comparison of the change from baseline in log proteinuria by analysis of covariance. Discussion The study will assess the effects of an individualized nutritional intervention on proteinuria 12 months after KTx. Trial registration REBEC (RBR-8XBQK5).

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Temporal changes of proteinuria after kidney transplantation: association with cardiovascular morbidity and mortality

Cited by 4 publications

References 30 publications

Evaluation of Salivary Indoxyl Sulfate with Proteinuria for Predicting Graft Deterioration in Kidney Transplant Recipients

Evaluation of Salivary Indoxyl Sulfate with Proteinuria for Predicting Graft Deterioration in Kidney Transplant Recipients

Microalbuminuria After Kidney Transplantation Predicts Cardiovascular Morbidity

Effects of an individualized nutritional intervention on kidney function, body composition, and quality of life in kidney transplant recipients: Study protocol for a randomized clinical trial

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