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      Longitudinal Serum Creatinine Levels in Relation to Graft Loss Following Renal Transplantation: Robust Joint Modeling of Longitudinal Measurements and Survival Time Data

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          Abstract

          Background

          Chronic kidney disease (CKD) is a major public health problem that may lead to end-stage renal disease (ESRD). Renal transplantation has become the treatment modality of choice for the majority of patients with ESRD. It is therefore necessary to monitor the disease progression of patients who have undergone renal transplantation. In order to monitor the disease progression, the continuous assessment of kidney function over time is considered.

          Objectives

          This study aimed to investigate the etiological role of recipient characteristics in serum creatinine changes within the follow-up period and in relation to the graft failure risk, as well as to evaluate whether or not the serum creatinine level represents an indicator of graft failure following renal transplantation.

          Methods

          This retrospective cohort study was conducted at the department of nephrology, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, between April 2005 and December 2008. The study involved 413 renal transplantation patients. The primary outcomes were the determination of the serum creatinine levels at each attendance and the time to graft failure. Robust joint modeling of the longitudinal measurements (serum creatinine level) and time-to-event data (time to graft failure) were used for the analysis in the presence of outliers in the serum creatinine levels. The data analysis was implemented in WinBUGS 1.4.3.

          Results

          There was a positive association between the serum creatinine level and graft failure (HR = 5.13, P < 0.001). A one unit increase in the serum creatinine level suggests an increased risk of graft failure of up to 5.13 times. The serum creatinine level significantly decreased over time (95% CI: (-1.58, -1.08)). The recipient’s age was negatively associated with the serum creatinine level (95% CI: (-0.02, -0.001)).

          Conclusions

          Graft failure is more likely to occur in patients with higher serum creatinine levels.

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          Most cited references24

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          Strategies to improve long-term outcomes after renal transplantation.

          Tom Theruvath, Nina Tolkoff-Rubin, Manuel Pascual … (2002)
          Article 0 comments Cited 123 times – based on 0 reviews     Review now
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            National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure.

            Joel D. Kopple (2000)
            The National Kidney Foundation Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in Chronic Renal Failure was recently published in the American Journal of Kidney Diseases. This publication provides 27 clinical practice guidelines for adults and 10 clinical practice guidelines for children. The adult guidelines focus primarily on patients undergoing maintenance dialysis therapy, although there are several clinical practice guidelines on nutritional issues for patients with advanced chronic renal failure (CRF) not undergoing dialysis therapy. The pediatric guidelines focus entirely on children undergoing maintenance dialysis treatment. The present article discusses a number of the more prominent clinical practice guidelines for the adults. Among these is the recommendation that the protein-energy nutritional status in these patients should be assessed by a panel of measures rather than by any single measure. Also, non-dialyzed patients with advanced CRF (ie, glomerular filtration rate /=60 years of age. Maintenance hemodialysis patients should be prescribed 1.2 g protein/kg/d; chronic peritoneal dialysis patients should be prescribed 1.2 to 1.3 g protein/kg/d. For non-dialyzed patients with CRF (glomerular filtration rate <25 mL/min), 0.60 g protein/kg/d should be prescribed. For patients who will not accept such a diet or are unable to maintain an adequate energy intake on that diet, a protein intake of up to 0.75 g protein/kg/d may be prescribed. At least 50% of the protein intake for all of these patients should be of high biologic value. A guideline concerning indications for inaugurating maintenance dialysis treatment or renal transplantation on the basis of deteriorating nutritional status is also given.
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              Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation.

              Agnès Debout, Yohann Foucher, Katy Trébern-Launay … (2015)
              Although cold ischemia time has been widely studied in renal transplantation area, there is no consensus on its precise relationship with the transplantation outcomes. To study this, we sampled data from 3839 adult recipients of a first heart-beating deceased donor kidney transplanted between 2000 and 2011 within the French observational multicentric prospective DIVAT cohort. A Cox model was used to assess the relationship between cold ischemia time and death-censored graft survival or patient survival by using piecewise log-linear function. There was a significant proportional increase in the risk of graft failure for each additional hour of cold ischemia time (hazard ratio, 1.013). As an example, a patient who received a kidney with a cold ischemia time of 30 h presented a risk of graft failure near 40% higher than a patient with a cold ischemia time of 6 h. Moreover, we found that the risk of death also proportionally increased for each additional hour of cold ischemia time (hazard ratio, 1.018). Thus, every additional hour of cold ischemia time must be taken into account in order to increase graft and patient survival. These findings are of practical clinical interest, as cold ischemia time is among one of the main modifiable pre-transplantation risk factors that can be minimized by improved management of the peri-transplantation period.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Nephrourol Mon
                Journal ID (iso-abbrev): Nephrourol Mon
                Journal ID (doi): 10.5812/numonthly
                Journal ID (publisher-id): Kowsar
                Title: Nephro-urology Monthly
                Publisher: Kowsar
                ISSN (Print): 2251-7006
                ISSN (Electronic): 2251-7014
                Publication date (Electronic): 01 August 2016
                Publication date Collection: September 2016
                Volume: 8
                Issue: 5
                Electronic Location Identifier: e39292
                Affiliations
                [1 ]Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
                [2 ]Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
                Author notes
                [* ]Corresponding author: Mohammad Reza Eshraghian, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188989127, E-mail: eshraghianm@ 123456tums.ac.ir eshraghianmr@ 123456yahoo.com
                Article
                DOI: 10.5812/numonthly.39292
                PMC ID: 5111091
                SO-VID: 5b680d31-ca16-48dc-9c07-6530c96ee64d
                Copyright © Copyright © 2016, Nephrology and Urology Research Center
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

                History
                Date received : 19 May 2016
                Date revision received : 11 June 2016
                Date accepted : 28 June 2016
                Categories
                Subject: Research Article

                Keywords: end-stage renal disease (esrd),graft loss,serum creatinine level,robust joint modeling,bayesian approach
                Data availability:
                Keywords: end-stage renal disease (esrd), graft loss, serum creatinine level, robust joint modeling, bayesian approach

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