Trajectories of glomerular filtration rate and progression to end stage kidney disease after kidney transplantation

Marc Raynaud, Olivier Aubert, Peter P. Reese, Yassine Bouatou, Maarten Naesens, Nassim Kamar, Élodie Bailly, Magali Giral, Marc Ladrière, Moglie Le Quintrec, Michel Delahousse, Ivana Juric, Nikolina Basic-Jukic, Gaurav Gupta, Enver Akalin, Daniel Yoo, Chen Shan Chin, Cécile Proust-Lima, Georg Böhmig, Rainer OberbauerMark D. Stegall, Andrew J. Bentall, Stanley C. Jordan, Edmund Huang, Denis Glotz, Christophe Legendre, Robert A. Montgomery, Dorry L. Segev, Jean Philippe Empana, Morgan E. Grams, Josef Coresh, Xavier Jouven, Carmen Lefaucheur, Alexandre Loupy

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Although the gold standard of monitoring kidney transplant function relies on glomerular filtration rate (GFR), little is known about GFR trajectories after transplantation, their determinants, and their association with outcomes. To evaluate these parameters we examined kidney transplant recipients receiving care at 15 academic centers. Patients underwent prospective monitoring of estimated GFR (eGFR) measurements, with assessment of clinical, functional, histological and immunological parameters. Additional validation took place in seven randomized controlled trials that included a total of 14,132 patients with 403,497 eGFR measurements. After a median follow-up of 6.5 years, 1,688 patients developed end-stage kidney disease. Using unsupervised latent class mixed models, we identified eight distinct eGFR trajectories. Multinomial regression models identified seven significant determinants of eGFR trajectories including donor age, eGFR, proteinuria, and several significant histological features: graft scarring, graft interstitial inflammation and tubulitis, microcirculation inflammation, and circulating anti-HLA donor specific antibodies. The eGFR trajectories were associated with progression to end stage kidney disease. These trajectories, their determinants and respective associations with end stage kidney disease were similar across cohorts, as well as in diverse clinical scenarios, therapeutic eras and in the seven randomized control trials. Thus, our results provide the basis for a trajectory-based assessment of kidney transplant patients for risk stratification and monitoring.

Original languageEnglish (US)
Pages (from-to)186-197
Number of pages12
JournalKidney international
Volume99
Issue number1
DOIs
StatePublished - Jan 2021

Keywords

  • end-stage renal disease
  • glomerular filtration rate
  • kidney function
  • kidney transplantation
  • mortality
  • trajectories

ASJC Scopus subject areas

  • Nephrology

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