Skip to main content
Journal cover image

Albuminuria and Allograft Failure, Cardiovascular Disease Events, and All-Cause Death in Stable Kidney Transplant Recipients: A Cohort Analysis of the FAVORIT Trial.

Publication ,  Journal Article
Weiner, DE; Park, M; Tighiouart, H; Joseph, AA; Carpenter, MA; Goyal, N; House, AA; Hsu, C-Y; Ix, JH; Jacques, PF; Kew, CE; Kim, SJ; Weir, MR ...
Published in: Am J Kidney Dis
January 2019

RATIONALE & OBJECTIVE: Cardiovascular disease (CVD) is common and overall graft survival is suboptimal among kidney transplant recipients. Although albuminuria is a known risk factor for adverse outcomes among persons with native chronic kidney disease, the relationship of albuminuria with cardiovascular and kidney outcomes in transplant recipients is uncertain. STUDY DESIGN: Post hoc longitudinal cohort analysis of the Folic Acid for Vascular Outcomes Reduction in Transplantation (FAVORIT) Trial. SETTING & PARTICIPANTS: Stable kidney transplant recipients with elevated homocysteine levels from 30 sites in the United States, Canada, and Brazil. PREDICTOR: Urine albumin-creatinine ratio (ACR) at randomization. OUTCOMES: Allograft failure, CVD, and all-cause death. ANALYTICAL APPROACH: Multivariable Cox models adjusted for age; sex; race; randomized treatment allocation; country; systolic and diastolic blood pressure; history of CVD, diabetes, and hypertension; smoking; cholesterol; body mass index; estimated glomerular filtration rate (eGFR); donor type; transplant vintage; medications; and immunosuppression. RESULTS: Among 3,511 participants with complete data, median ACR was 24 (Q1-Q3, 9-98) mg/g, mean eGFR was 49±18 (standard deviation) mL/min/1.73m2, mean age was 52±9 years, and median graft vintage was 4.1 (Q1-Q3, 1.7-7.4) years. There were 1,017 (29%) with ACR < 10mg/g, 912 (26%) with ACR of 10 to 29mg/g, 1,134 (32%) with ACR of 30 to 299mg/g, and 448 (13%) with ACR ≥ 300mg/g. During approximately 4 years, 282 allograft failure events, 497 CVD events, and 407 deaths occurred. Event rates were higher at both lower eGFRs and higher ACR. ACR of 30 to 299 and ≥300mg/g relative to ACR < 10mg/g were independently associated with graft failure (HRs of 3.40 [95% CI, 2.19-5.30] and 9.96 [95% CI, 6.35-15.62], respectively), CVD events (HRs of 1.25 [95% CI, 0.96-1.61] and 1.55 [95% CI, 1.13-2.11], respectively), and all-cause death (HRs of 1.65 [95% CI, 1.23-2.21] and 2.07 [95% CI, 1.46-2.94], respectively). LIMITATIONS: No data for rejection; single ACR assessment. CONCLUSIONS: In a large population of stable kidney transplant recipients, elevated baseline ACR is independently associated with allograft failure, CVD, and death. Future studies are needed to evaluate whether reducing albuminuria improves these outcomes.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

January 2019

Volume

73

Issue

1

Start / End Page

51 / 61

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Risk Assessment
  • Postoperative Complications
  • Middle Aged
  • Male
  • Longitudinal Studies
  • Kidney Transplantation
  • Humans
  • Graft Survival
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Weiner, D. E., Park, M., Tighiouart, H., Joseph, A. A., Carpenter, M. A., Goyal, N., … Bostom, A. G. (2019). Albuminuria and Allograft Failure, Cardiovascular Disease Events, and All-Cause Death in Stable Kidney Transplant Recipients: A Cohort Analysis of the FAVORIT Trial. Am J Kidney Dis, 73(1), 51–61. https://doi.org/10.1053/j.ajkd.2018.05.015
Weiner, Daniel E., Meyeon Park, Hocine Tighiouart, Alin A. Joseph, Myra A. Carpenter, Nitender Goyal, Andrew A. House, et al. “Albuminuria and Allograft Failure, Cardiovascular Disease Events, and All-Cause Death in Stable Kidney Transplant Recipients: A Cohort Analysis of the FAVORIT Trial.Am J Kidney Dis 73, no. 1 (January 2019): 51–61. https://doi.org/10.1053/j.ajkd.2018.05.015.
Weiner DE, Park M, Tighiouart H, Joseph AA, Carpenter MA, Goyal N, et al. Albuminuria and Allograft Failure, Cardiovascular Disease Events, and All-Cause Death in Stable Kidney Transplant Recipients: A Cohort Analysis of the FAVORIT Trial. Am J Kidney Dis. 2019 Jan;73(1):51–61.
Weiner, Daniel E., et al. “Albuminuria and Allograft Failure, Cardiovascular Disease Events, and All-Cause Death in Stable Kidney Transplant Recipients: A Cohort Analysis of the FAVORIT Trial.Am J Kidney Dis, vol. 73, no. 1, Jan. 2019, pp. 51–61. Pubmed, doi:10.1053/j.ajkd.2018.05.015.
Weiner DE, Park M, Tighiouart H, Joseph AA, Carpenter MA, Goyal N, House AA, Hsu C-Y, Ix JH, Jacques PF, Kew CE, Kim SJ, Kusek JW, Pesavento TE, Pfeffer MA, Smith SR, Weir MR, Levey AS, Bostom AG. Albuminuria and Allograft Failure, Cardiovascular Disease Events, and All-Cause Death in Stable Kidney Transplant Recipients: A Cohort Analysis of the FAVORIT Trial. Am J Kidney Dis. 2019 Jan;73(1):51–61.
Journal cover image

Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

January 2019

Volume

73

Issue

1

Start / End Page

51 / 61

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Risk Assessment
  • Postoperative Complications
  • Middle Aged
  • Male
  • Longitudinal Studies
  • Kidney Transplantation
  • Humans
  • Graft Survival