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C‐Reactive Protein and Body Mass Index Independently Predict Mortality in Kidney Transplant Recipients
Author(s) -
Winkelmayer Wolfgang C.,
Lorenz Matthias,
Kramar Reinhard,
Födinger Manuela,
Hörl Walter H.,
SunderPlassmann Gere
Publication year - 2004
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/j.1600-6143.2004.00477.x
Subject(s) - medicine , hazard ratio , proportional hazards model , body mass index , c reactive protein , dialysis , prospective cohort study , kidney transplantation , confidence interval , univariate analysis , population , transplantation , multivariate analysis , gastroenterology , surgery , inflammation , environmental health
C‐reactive protein (CRP) is a risk factor for cardiovascular outcomes and mortality in the general population. To date, there are no prospective studies of the association between CRP and mortality or allograft loss in kidney transplant recipients (KTR). In 1995, 438 consecutive KTR were enrolled in this prospective study. Important information on demographic, clinical and immunological characteristics was collected at baseline, and CRP was measured using standard methods. Patients were then followed‐up for a median 7.8 years. Time‐to‐event analyses (univariate and multivariate Cox proportional hazards regression models) were used to study the main outcomes: all‐cause mortality and kidney allograft loss, defined as the earlier of return to dialysis, re‐transplantation, or death. From univariate analyses, we found that CRP ≥0.5 mg/dL was associated with a 83% greater mortality risk compared with lower levels of this inflammatory marker [hazard ratio (HR) = 1.83; 95% confidence interval (CI): 1.23–2.72; p = 0.003]. After multivariate adjustment, patients with a CRP ≥0.5 mg/dL had a 53% higher mortality risk compared with patients whose CRP was below that threshold (HR = 1.53; 95% CI: 1.01–2.31; p = 0.04). No associations between CRP and the risk of kidney allograft loss were detected. Furthermore, we were not able to detect any effect modification between CRP and body mass index on the outcomes under study. We conclude that CRP predicts all‐cause mortality, but not allograft loss in stable KTR.