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Filtration Markers, Cardiovascular Disease, Mortality, and Kidney Outcomes in Stable Kidney Transplant Recipients: The FAVORIT Trial
Author(s) -
Foster M. C.,
Weiner D. E.,
Bostom A. G.,
Carpenter M. A.,
Inker L. A.,
Jarolim P.,
Joseph A. A.,
Kusek J. W.,
Pesavento T.,
Pfeffer M. A.,
Rao M.,
Solomon S. D.,
Levey A. S.
Publication year - 2017
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14258
Subject(s) - medicine , renal function , hazard ratio , creatinine , kidney disease , cystatin c , kidney transplantation , urology , kidney , confidence interval , gastroenterology
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 ( eGFR cys ), B2M ( eGFR B 2M ), and creatinine ( eGFR cr ) 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 eGFR cr , eGFR cys , and eGFR B 2M were 46.0, 43.8, and 48.8 mL /min/1.73m 2 , respectively. After multivariable adjustment, hazard ratios for eGFR cys and eGFR B 2M <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 eGFR cr . We conclude that cystatin C and B2M are strongly associated with cardiovascular events, mortality, and kidney failure in stable kidney transplant recipients.