5 years ago

Filtration Markers, Cardiovascular Disease, Mortality, and Kidney Outcomes in Stable Kidney Transplant Recipients: The FAVORIT Trial

T. Pesavento, L. A. Inker, A. G. Bostom, D. E. Weiner, A. A. Joseph, P. Jarolim, M. C. Foster, S. D. Solomon, J. W. Kusek, M. A. Pfeffer, A. S. Levey, M. Rao, M. A. Carpenter
Cystatin C and beta-2-microglobulin (B2M) are filtration markers associated with adverse outcomes in nontransplant populations, sometimes with stronger associations than for creatinine. We evaluated associations of estimated glomerular filtration rate from cystatin C (eGFRcys), B2M (eGFRB2M), and creatinine (eGFRcr) with cardiovascular outcomes, mortality, and kidney failure in stable kidney transplant recipients using a case–cohort study nested within the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial. A random subcohort was selected (N = 508; mean age 51.6 years, median transplant vintage 4 years, 38% women, 23.6% nonwhite race) with enrichment for cardiovascular events (N = 306; 54 within the subcohort), mortality (N = 208; 68 within the subcohort), and kidney failure (N = 208; 52 within the subcohort). Mean eGFRcr, eGFRcys, and eGFRB2M were 46.0, 43.8, and 48.8 mL/min/1.73m2, respectively. After multivariable adjustment, hazard ratios for eGFRcys and eGFRB2M <30 versus 60+ were 2.02 (95% confidence interval [CI] 1.09–3.76; p = 0.03) and 2.56 (1.35–4.88; p = 0.004) for cardiovascular events; 3.92 (2.11–7.31) and 4.09 (2.21–7.54; both p < 0.001) for mortality; and 9.49 (4.28–21.00) and 15.53 (6.99–34.51; both p < 0.001) for kidney failure. Associations persisted with additional adjustment for baseline eGFRcr. We conclude that cystatin C and B2M are strongly associated with cardiovascular events, mortality, and kidney failure in stable kidney transplant recipients.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14258

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