In 2012, the KDIGO guidelines updated the classification system for chronic kidney disease to include albuminuria. Whether this classification system prognosticates adverse clinical outcomes among kidney transplant recipients is unclear. We conducted a retrospective study using linked databases in Alberta, Canada to follow kidney transplant recipients from 2002-2011. We examined the association between estimated glomerular filtration rate (eGFR, ≥60, 45-59, 30-44, 15-29 mL/min/1.73 m²) and albuminuria (normal, mild, heavy) at 1-year post-transplant and subsequent mortality and graft loss. There were 900 recipients with a functioning graft and at least 1 outpatient serum creatinine and urine protein measurement at 1-year post-transplant. Median age was 51.2 years, 38.7% were female, and 52.0% had an eGFR ≥60 mL/min/1.73 m². The risk of all-cause mortality and death-censored graft loss was increased in recipients with reduced eGFR or heavier albuminuria. The adjusted incidence rate per 1000 person-years of all-cause mortality for recipients with an eGFR 15-29 mL/min/1.73 m² and heavy albuminuria vs. eGFR >60 mL/min/1.73 m² and normal protein excretion was 116.6 (95% CI 38.2-371.4) vs. 14.9 (95% CI 9.3-22.9) (rate ratio 7.9, 95% CI 3.3-18.8). Corresponding rates for death-censored graft loss were 272.9 (95% CI 88.1-1202.7) vs. 5.5 (95% CI 2.7-9.1) (rate ratio 49.4, 95% CI 17.4-140.6). Reduced eGFR and heavier albuminuria in kidney transplant recipients are associated with an increased risk of mortality and graft loss. These findings suggest that eGFR and albuminuria can be used together to identify, evaluate, and manage transplant recipients who are at higher risk of adverse clinical outcomes.

CITATION INFORMATION: Lam N, Tonelli M, Lentine K, Hemmelgarn B, Ye F, Wen K, Klarenbach S. Renal Function, Albuminuria, and the Risk of Death and Graft Loss After Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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