Renal Function In Kidney Transplant Recipients Research Articles

#5547 SERUM PERIOSTIN IN KIDNEY TRANSPLANT RECIPIENTS AS A NOVEL BIOMARKER PREDICTING RENAL FUNCTION LOSS

Abstract Background and Aims Experimental studies have shown periostin is expressed throughout organogenesis, particularly within the kidney interstitium. Periostin is enhanced in different tissues of patients with nephropathy and has been considered as a candidate biomarker of kidney injury. Method Retrospective analysis of electronic medical record of one hundred and five kidney transplant recipients (KTRs) was performed. Only patients under sequential ambulatory care, with a history of at least 2 years post-transplant were included. Median (IQR) follow-up and time post-transplant was 4.42 (2.65, 4.58) and 4.29 (3.04, 8.07) years, respectively. Additionally, thirty-two health volunteers (HV) were enrolled. Biochemical testing was performed using commercially-available immunoassays. Results Median [IQR] serum periostin was significantly lower in KTRs as compared with HV (959 [732, 1204] vs. 1176 [997, 1408]; P<0.01). Higher serum periostin was observed in male patients (7.01 [6.84, 7.22] vs. 6.79 [6.64, 7.07], P<0.05) and a significant relationship was noted for interleukin 6 (IL6; r=0.24, P=0.01) and baseline estimated glomerular filtration (eGFR) (r=0.20, P=0.04). Patient age (P=0.60), body-mass index P=0.08), cardiovascular disease (P=0.31), diabetes (P=0.45), current smoker status (P=0.27), nor anemia (P=0.23) were not associated with serum periostin. In a generalized additive model adjusted for baseline renal function and IL-6, serum periostin showed a signficant nonlinear association (P=0.04) with eGFR change over follow-up. Conclusion Previous studies reported an association between periostin expression and the severity of histological injury within the kidney in both inflammatory and non-inflammatory conditions. Serum periostin may be a potential marker aiding in prediction of renal function in KTRs.

Belatacept and Long-Term Outcomes in Kidney Transplantation

BackgroundIn previous analyses of BENEFIT, a phase 3 study, belatacept-based immunosuppression, as compared with cyclosporine-based immunosuppression, was associated with similar patient and graft survival and significantly improved renal function in kidney-transplant recipients. Here we present the final results from this study.MethodsWe randomly assigned kidney-transplant recipients to a more-intensive belatacept regimen, a less-intensive belatacept regimen, or a cyclosporine regimen. Efficacy and safety outcomes for all patients who underwent randomization and transplantation were analyzed at year 7 (month 84).ResultsA total of 666 participants were randomly assigned to a study group and underwent transplantation. Of the 660 patients who were treated, 153 of the 219 patients treated with the more-intensive belatacept regimen, 163 of the 226 treated with the less-intensive belatacept regimen, and 131 of the 215 treated with the cyclosporine regimen were followed for the full 84-month period; all available data were used in the analysis. A 43% reduction in the risk of death or graft loss was observed for both the more-intensive and the less-intensive belatacept regimens as compared with the cyclosporine regimen (hazard ratio with the more-intensive regimen, 0.57; 95% confidence interval [CI], 0.35 to 0.95; P=0.02; hazard ratio with the less-intensive regimen, 0.57; 95% CI, 0.35 to 0.94; P=0.02), with equal contributions from the lower rates of death and graft loss. The mean estimated glomerular filtration rate (eGFR) increased over the 7-year period with both belatacept regimens but declined with the cyclosporine regimen. The cumulative frequencies of serious adverse events at month 84 were similar across treatment groups.ConclusionsSeven years after transplantation, patient and graft survival and the mean eGFR were significantly higher with belatacept (both the more-intensive regimen and the less-intensive regimen) than with cyclosporine. (Funded by Bristol-Myers Squibb; ClinicalTrials.gov number, NCT00256750.)

Performance of estimated glomerular filtration rates to monitor change in renal function in kidney transplant recipients

Glomerular filtration rate estimates (e-GFR) are often used to evaluate the changes in renal function, but have not been validated for this purpose in kidney transplant recipients (KTRs). The aim of this study was to evaluate the validity of e-GFR for monitoring serial changes in renal function in KTR using directly measured GFR by inulin clearance (I-GFR) as the reference standard. Performances of inverse serum creatinine (1/creat) and Cockcroft and Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology Collaboration formulas were assessed to estimate the changes in I-GFR. A total of 1935 I-GFR clearance procedures were performed in 631 KTRs who underwent serial measurements between 2003 and 2009. The baseline median I-GFR were 51.0 mL/min/1.73 m(2) (confidence interval 95%: 23-84 mL/min/1.73 m(2)]. The performances of 1/creat and formulas for detecting the I-GFR variations between two consecutive measurements (n = 1304) were similar. To detect the variations of <20% (increase or decrease), sensitivities ranged between 50 and 56%, and specificities between 64 and 69%. To detect the variations >20% (increase or decrease), sensitivities ranged between 27% and 39%, and specificities between 88 and 97%. Bland-Altman plots confirmed the scattering of values for individual patients. In a population of Caucasian KTRs, the mean changes in GFR are correctly estimated whatever the formula used in the range of 23-84 mL/min/1.73 m(2) and can thus be applied in population studies. However, in clinical practice, individual changes in GFR evaluated by formulas should be interpreted with caution in KTRs.

British consensus guidelines on intravenous fluid therapy for adult surgical patients (GIFTASUP) – Cassandra’s view

British consensus guidelines on intravenous fluid therapy for adult surgical patients (GIFTASUP) – Cassandra’s view

Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients

Hydroxyethylstarch used as a plasma-volume expander in brain-dead kidney donors has been suggested to induce osmotic-nephrosis-like lesions. We have studied its effect on kidney-transplant function. 52 patients who had received hydroxyethylstarch of iodinated contrast-media before brain death were excluded. 69 other brain-dead patients were prospectively included over 18 months and randomised into two groups. In the hydroxyethylstarch-gelatin group, patients received hydroxyethylstarch up to 33 mL/kg for colloid plasma-volume expansion, and afterwards received modified fluid gelatin. In the gelatin-only group, patients received only modified fluid gelatin as colloid plasma-volume expander. Multiple organs were procured in 29 cases, which included the kidneys in 27 cases (hydroxyethylstarch-gelatin 15, gelatin-only 12). There were no significant differences in the characteristics of patients between the two groups of kidney donors or of recipients (except for a small imbalance in sex in the recipients). During the first 8 days after transplantation, nine of 27 (33%) patients required extrarenal haemodialysis or haemodiafiltration in the hydroxyethylstarch-gelatin group compared with one of 20 (5%) in the gelatin-only group (p = 0.029). Serum creatinine concentrations were significantly lower in the gelatin-only group than in the other group (p = 0.009). 10 days after transplantation, mean (SD) serum creatinine was, respectively, 145 (70) and 312 (259) mumol/L. These data suggest that hydroxyethylstarch used as a plasma-volume expander in brain-dead donors impairs immediate renal function in kidney-transplant recipients.