Assessment of nonimmunologic factors in kidney transplant recipients according to Kidney Disease Improving Global Outcomes.

INTRODUCTION

Cardiovascular disease is the primary cause of death among kidney transplant recipients (KTRs), whereas chronic allograft nephropathy (CAN) is the main reason leading to end-stage chronic kidney disease. The etiologies of both entities include immunologic and nonimmunologic factors. The management of modifiable nonimmunologic parameters has recently been identified by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. The aim of our study was to assess the implementation of these guidelines in the outpatient kidney transplantation clinic of our hospital.

PATIENT AND

METHODS

We retrospectively monitored the records of 48 transplanted KTRs including 32 males of overall mean age 45.1 ± 10.7 years regarding control of anemia, dyslipidemia, mineral bone disorder (MBD), and blood pressure (BP) levels. Data were recorded every 6 months for 2 years, starting 1 year after renal transplantation.

RESULTS

The estimated glomerular filtration rate of patients at baseline was 60.3 ± 18.8 mL/min/1.73 m(2) with no significant change during 2 years of follow-up. The control of anemia was satisfactory in 42 patients (88%) with hemoglobin values ≥ 11 g/dL during the follow-up. Regarding dyslipidemia management, the aggregate of patients showed fasting triglycerides ≤500 mg/dL in all measurements. The percentage of KTRs with LDL ≤100 mg/dL tended to improve from baseline versus the end of the study period (20.8% vs 41.7%). Serum calcium was satisfactorily controlled in 77% of patients, serum phosphorus in all patients, whereas parathyroid hormone (PTH) was abnormal in 60% of KTRs with chronic kidney disease stages 3-5. Finally, the BP goal of <130/80 mm Hg was achieved in approximately half of the patients.

CONCLUSION

Control of nonimmunologic factors was satisfactory in terms of renal anemia and MBD, whereas dyslipidemia and BP levels were inadequately controlled. There is a clear need for better integration into clinical practice of KDIGO guidelines with regard to modifiable nonimmunologic factors.