scholarly journals Urinary 3-hydroxyisovaleryl carnitine excretion, protein energy malnutrition and risk of all-cause mortality in kidney transplant recipients: Results from the TransplantLines cohort studies

2020 ◽  
Author(s):  
Adrian Post ◽  
M. Yusof Said ◽  
Antonio W. Gomes-Neto ◽  
Isidor Minović ◽  
Dion Groothof ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Kidney Transplant ◽  
Protein Energy Malnutrition ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Protein Energy ◽  
All Cause Mortality

Abstract 16810: Myocardial Perfusion Abnormalities, Ejection Fraction, and Coronary Calcium Score Are Not Associated With All-Cause Mortality Among Potential Kidney Transplant Recipients at Emory University Hospital

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ryan S Cousins ◽  
Billy Mullinax ◽  
Lehman Godwin ◽  
Adam J Mitchell
Keyword(s):  
Multivariate Analysis ◽  
Coronary Artery ◽  
Kidney Transplant ◽  
Stress Testing ◽  
University Hospital ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Evaluation ◽  
Emory University ◽  
All Cause Mortality

Introduction: Screening for coronary artery disease in patients being considered for kidney transplant is common to stratify morbidity and mortality risk, but the optimal strategy, and its impact on outcomes, remains unclear. Here we test the hypothesis that myocardial perfusion imaging (MPI) abnormalities, left ventricular ejection fraction (LVEF), or coronary artery calcium (CAC) score are associated with all-cause mortality in potential kidney transplant recipients at Emory University Hospital (EUH). Methods: In a retrospective chart review, we assessed the relationship between patient demographics, single-photon emission MPI results, and CAC scoring with post-evaluation outcomes at 5 years in consecutive patients referred for pre-transplant stress testing at EUH in 2015. Mann-Whitney U and Chi-Square tests assessed between-group differences in continuous and categorical variables, respectively. Multivariate analysis was performed using logistic regression models. Results: During the study period, 589 patients (mean age 54 years; SEM 0.512, 58% male, 65% African American) underwent MPI and 424 also underwent CAC scoring. Overall, 90 patients (15%) had abnormal MPI (defined as any fixed or reversible defect) and 54 (9%) died during follow up. Age (mean 53.2 years; SEM 0.533 vs. 57.7 years; SEM 1.73, p=0.008), previous coronary artery bypass graft (CABG) (2.06% vs. 7.41%, p=0.017), and myocardial infarction (MI) post-evaluation (4.11% vs. 18.5%, p<0.001) were associated with all-cause mortality. Age (p=0.032) and MI post-evaluation (p<0.001) remained significant in multivariate analysis. MPI abnormalities, LVEF, and CAC score were not associated with all-cause mortality. Conclusions: Age and MI post-evaluation are associated with increased mortality in potential kidney transplant recipients referred for stress testing at EUH. We found no association between MPI abnormalities, LVEF, or CAC score and all-cause mortality.

scholarly journals Osmoregulation Performance and Kidney Transplant Outcome

2019 ◽  
Vol 30 (7) ◽  
pp. 1282-1293 ◽  
Author(s):  
Manal Mazloum ◽  
Jordan Jouffroy ◽  
François Brazier ◽  
Christophe Legendre ◽  
Antoine Neuraz ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Renal Outcome ◽  
Plasma Sodium ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Loading Test ◽  
Water Loading ◽  
All Cause Mortality ◽  
Allograft Loss ◽  
Transplantation Outcomes

BackgroundKidney transplant recipients have an impaired ability to dilute urine but seldom develop baseline hyponatremia before ESRD. Although hyponatremia is a risk factor for adverse events in CKD and in kidney transplant recipients, it remains unclear whether subtler alterations in osmoregulation performance are associated with outcome.MethodsWe studied a single-center prospective cohort of 1258 kidney transplant recipients who underwent a water-loading test 3 months after transplant to determine osmoregulation performance. Measured GFR (mGFR) was performed at the same visit. A group of 164 healthy candidates for kidney donation served as controls. We further evaluated the association of osmoregulation performance with transplantation outcomes and subsequent kidney function.ResultsUnlike controls, most kidney transplant recipients failed to maintain plasma sodium during water loading (plasma sodium slope of −0.6±0.4 mmol/L per hour in transplant recipients versus −0.12±0.3 mmol/L per hour in controls; P<0.001). Steeper plasma sodium reduction during the test independently associated with the composite outcome of all-cause mortality and allograft loss (hazard ratio [HR], 1.73 per 1 mmol/L per hour decrease in plasma sodium; 95% confidence interval [95% CI], 1.23 to 2.45; P=0.002) and allograft loss alone (HR, 2.04 per 1 mmol/L per hour decrease in plasma sodium; 95% CI, 1.19 to 3.51; P=0.01). The association remained significant in a prespecified sensitivity analysis excluding patients with hyperglycemia. In addition, a steeper plasma sodium slope 3 months after transplantation independently correlated with lower mGFR at 12 months (β=1.93; 95% CI, 0.46 to 3.41; P=0.01).ConclusionsReduced osmoregulation performance occurs frequently in kidney transplant recipients and is an independent predictor of renal outcome.

scholarly journals Pretransplant Physical Activity Predicts All-Cause Mortality in Kidney Transplant Recipients

2011 ◽  
Vol 35 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Sylvia E. Rosas ◽  
Peter P. Reese ◽  
Yonghong Huan ◽  
Cataldo Doria ◽  
Philip T. Cochetti ◽  
...  
Keyword(s):  
Physical Activity ◽  
Kidney Transplant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
All Cause Mortality

scholarly journals Sclerostin is an independent risk factor for all-cause mortality in kidney transplant recipients

2020 ◽  
Vol 24 (12) ◽  
pp. 1177-1183
Author(s):  
Shufei Zeng ◽  
Torsten Slowinski ◽  
Wolfgang Pommer ◽  
Ahmed A. Hasan ◽  
Mohamed M. S. Gaballa ◽  
...  
Keyword(s):  
Risk Factor ◽  
Renal Transplant ◽  
Kidney Transplant ◽  
Independent Risk Factor ◽  
Cox Regression ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Kaplan Meier ◽  
All Cause Mortality

Abstract Background Sclerostin is a hormone contributing to the bone-vascular wall cross talk and has been implicated in cardiovascular events and mortality in patients with chronic kidney disease (CKD). We analyzed the relationship between sclerostin and mortality in renal transplant recipients. Methods 600 stable renal transplant recipients (367men, 233 women) were followed for all-cause mortality for 3 years. Blood and urine samples for analysis and clinical data were collected at study entry. We performed Kaplan–Meier survival analysis and Cox regression models considering confounding factors such as age, eGFR, cold ischemia time, HbA1c, phosphate, calcium, and albumin. Optimal cut-off values for the Cox regression model were calculated based on ROC analysis. Results Sixty-five patients died during the observation period. Nonsurvivors (n = 65; sclerostin 57.31 ± 30.28 pmol/L) had higher plasma sclerostin levels than survivors (n = 535; sclerostin 47.52 ± 24.87 pmol/L) (p = 0.0036). Kaplan–Meier curve showed that baseline plasma sclerostin concentrations were associated with all-cause mortality in stable kidney transplant recipients (p = 0.0085, log-rank test). After multiple Cox regression analysis, plasma levels of sclerostin remained an independent predictor of all-cause mortality (hazard ratio, 1.011; 95% CI 1.002–1.020; p = 0.0137). Conclusions Baseline plasma sclerostin is an independent risk factor for all-cause mortality in patients after kidney transplantation.

scholarly journals Physical activity and risk of cardiovascular events and all-cause mortality among kidney transplant recipients

2020 ◽  
Vol 35 (8) ◽  
pp. 1436-1443
Author(s):  
Augustine W Kang ◽  
Andrew G Bostom ◽  
Hongseok Kim ◽  
Charles B Eaton ◽  
Reginald Gohh ◽  
...  
Keyword(s):  
Physical Activity ◽  
Kidney Transplant ◽  
Proportional Hazards ◽  
Controlled Trial ◽  
Cox Proportional Hazards ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cvd Risk ◽  
All Cause Mortality ◽  
Cvd Mortality

Abstract Background Insufficient physical activity (PA) may increase the risk of all-cause mortality and cardiovascular disease (CVD) morbidity and mortality among kidney transplant recipients (KTRs), but limited research is available. We examine the relationship between PA and the development of CVD events, CVD death and all-cause mortality among KTRs. Methods A total of 3050 KTRs enrolled in an international homocysteine-lowering randomized controlled trial were examined (38% female; mean age 51.8 ± 9.4 years; 75% white; 20% with prevalent CVD). PA was measured at baseline using a modified Yale Physical Activity Survey, divided into tertiles (T1, T2 and T3) from lowest to highest PA. Kaplan–Meier survival curves were used to graph the risk of events; Cox proportional hazards regression models examined the association of baseline PA levels with CVD events (e.g. stroke, myocardial infarction), CVD mortality and all-cause mortality over time. Results Participants were followed up to 2500 days (mean 3.7 ± 1.6 years). The cohort experienced 426 CVD events and 357 deaths. Fully adjusted models revealed that, compared to the lowest tertile of PA, the highest tertile experienced a significantly lower risk of CVD events {hazard ratio [HR] 0.76 [95% confidence interval (CI) 0.59–0.98]}, CVD mortality [HR 0.58 (95% CI 0.35–0.96)] and all-cause mortality [HR 0.76 (95% CI 0.59–0.98)]. Results were similar in unadjusted models. Conclusions PA was associated with a reduced risk of CVD events and all-cause mortality among KTRs. These observed associations in a large, international sample, even when controlling for traditional CVD risk factors, indicate the potential importance of PA in reducing CVD and death among KTRs.

scholarly journals Urinary Oxalate Excretion and Long-Term Outcomes in Kidney Transplant Recipients

2019 ◽  
Vol 8 (12) ◽  
pp. 2104 ◽  
Author(s):  
Alwin Tubben ◽  
Camilo G. Sotomayor ◽  
Adrian Post ◽  
Isidor Minovic ◽  
Timoer Frelink ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Kidney Transplant ◽  
Graft Failure ◽  
Inverse Association ◽  
Urinary Oxalate ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Oxalate Excretion ◽  
All Cause Mortality ◽  
Urinary Oxalate Excretion

Epidemiologic studies have linked urinary oxalate excretion to risk of chronic kidney disease (CKD) progression and end-stage renal disease. We aimed to investigate whether urinary oxalate, in stable kidney transplant recipients (KTR), is prospectively associated with risk of graft failure. In secondary analyses we evaluated the association with post-transplantation diabetes mellitus, all-cause mortality and specific causes of death. Oxalate excretion was measured in 24-h urine collection samples in a cohort of 683 KTR with a functioning allograft ≥1 year. Mean eGFR was 52 ± 20 mL/min/1.73 m2. Median (interquartile range) urinary oxalate excretion was 505 (347–732) µmol/24-h in women and 519 (396–736) µmol/24-h in men (p = 0.08), with 302 patients (44% of the study population) above normal limits (hyperoxaluria). A consistent and independent inverse association was found with all-cause mortality (HR 0.77, 95% CI 0.63–0.94, p = 0.01). Cause-specific survival analyses showed that this association was mainly driven by an inverse association with mortality due to infection (HR 0.56, 95% CI 0.38–0.83, p = 0.004), which remained materially unchanged after performing sensitivity analyses. Twenty-four-hour urinary oxalate excretion did not associate with risk of graft failure, post-transplant diabetes mellitus, cardiovascular mortality, mortality due to malignancies or mortality due to miscellaneous causes. In conclusion, in KTR, 24-h urinary oxalate excretion is elevated in 44% of KTR and inversely associated with mortality due to infectious causes.

Abstract MP35: Physical Activity and Risk of Cardiovascular Events and All-Cause Mortality Among Kidney Transplant Recipients

Circulation ◽  
2019 ◽  
Vol 139 (Suppl_1) ◽  
Author(s):  
Augustine Kang ◽  
Hongseok Kim ◽  
Carol E Garber ◽  
Charles Eaton ◽  
Patricia M Risica ◽  
...  
Keyword(s):  
Physical Activity ◽  
Kidney Transplant ◽  
Cardiovascular Events ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
All Cause Mortality

scholarly journals Kidney Function-Dependence of Vitamin K-Status Parameters: Results from the TransplantLines Biobank and Cohort Studies

Nutrients ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 3069
Author(s):  
Daan Kremer ◽  
Dion Groothof ◽  
Charlotte A. Keyzer ◽  
Coby Eelderink ◽  
Tim J. Knobbe ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Cohort Studies ◽  
Kidney Transplant ◽  
Kidney Function ◽  
Vitamin K ◽  
Matrix Gla Protein ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Blood Concentrations ◽  
K Deficiency

High circulating dephosphorylated (dp) uncarboxylated (uc) matrix Gla protein (MGP) and uc osteocalcin (OC) concentrations are regarded as markers of vitamin K-deficiency. However, because MGP and OC are small molecules, they may potentially pass the glomerulus, and their blood concentrations may strongly depend on kidney function. However, many studies with vitamin K-status parameters do not structurally adjust for baseline kidney function, and detailed studies on kidney function-dependence of vitamin K-status markers are lacking. We therefore measured plasma dp-ucMGP using a chemiluminescent assay in 578 kidney transplant recipients (41% females, age 56 ± 13y, 7.5 (3.2 to 13.7)y after transplantation, eGFR 49 ± 17 mL/min/1.73 m2) participating in the prospective TransplantLines Cohort Studies. Additionally, dp-carboxylated MGP, ucOC and carboxylated OC were measured using ELISA in plasma of a subgroup of 60 participants. Finally, dp-ucMGP was measured in a separate cohort of 124 kidney transplant recipients before and three months after kidney transplantation. Dp-ucMGP positively correlated with creatinine, cystatin C, and negatively with eGFR (Spearman’s ρ 0.54, 0.60, and −0.54, respectively, p < 0.001 for all), and each 10 mL/min/1.73 m2 increase in eGFR was associated with a 14.0% lower dp-ucMGP. Additionally, dp-ucMGP strongly declined after kidney transplantation (pretransplantation: 1252 (868 to 1744) pmol/L to posttransplantation: 609 (451 to 914) pmol/L, p < 0.001). Proportions of dp-ucMGP over total MGP and ucOC over total OC were not associated with eGFR. This study highlights that dp-ucMGP is strongly associated with kidney function, and that levels strongly decrease after kidney transplantation. We therefore propose adequate adjustment for kidney function, or the use of kidney function-independent parameters such as proportion of uncarboxylated MGP or OC in the assessment of vitamin K-status in clinical practice and research.

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