Rationale & Objective
Cardiovascular disease (CVD) is common amongst kidney transplant recipients and overall graft survival is suboptimal among these individuals. Although albuminuria is a known risk factor for adverse outcomes among persons with native chronic kidney disease (CKD), the relationship of albuminuria with cardiovascular and kidney outcomes in transplant recipients is uncertain. The study, described hereunder, is an analysis of the Folic Acid for Vascular Outcomes Reduction in Transplantation (FAVORIT) Trial.
Study Design
This was a post hoc longitudinal cohort analysis carried out according to the methodology described in Table 1.
The study was carried out using the methodology described in Table 1.
CVD: cardiovascular disease
Key Results
Event rates were higher at both lower eGFRs and higher urine albumin-creatinine ratio (ACR).
Allograft Failure
There was statistically significant increased risk for allograft failure among those with ACR of 30 to <300 mg/g (HR=3.4) and ≥300 mg/g (HR=9.96) compared to those with ACR<10 mg/g.
Cardiovascular Outcomes
Amongst those with ACR of 30 to <300 mg/g, the risk of CVD was nominally elevated, although not statistically significant (HR=1.25) while there was a statistically significant increased risk for CVD (HR=1.55) among those with ACR ≥300 mg/g.
Mortality Outcomes
There was statistically significant increased risk for death among those with ACR of 30 to <300 mg/g (HR=1.65) and ≥300 mg/g (HR=2.07) compared to those with ACR <10 mg/g.
Composite Outcome
There was statistically significant increased risk for allograft failure–mortality composite among those with ACR of 30 to <300 mg/g (HR=2.2) and ≥300 mg/g (HR=4.55) compared to those with ACR <10 mg/g. These results have been depicted in Figure 1.
Conclusion
In a large population of stable kidney transplant recipients, elevated baseline ACR is independently associated with allograft failure, CVD and death. Future studies are needed to assess the impact of reducing albuminuria in improving these outcomes.
Source: Weiner DE, Park M, Tighiouart H, et al. American Journal of Kidney Diseases. 2019;73(1):51-61.
