Chronic kidney disease (CKD) stage, defined by estimated glomerular filtration rate (eGFR) and urinary protein excretion, predicts outcomes in native CKD, but the associations of these markers with outcomes in kidney transplant recipients are less clear.

We examined the separate and joint associations of eGFR and urinary protein:creation ratio (UPr:Cr) at one year post-transplant with death or graft failure among 1688 patients receiving a kidney transplant at the University of Wisconsin from 2000-2009. A total of 160 graft failures and 173 deaths occurred during a median follow-up of 3.9 years.

Patients with lower eGFR were older, had older donors, and were more likely to be male, have diabetes, received a graft from a deceased donor, and experienced delayed graft function (all p≤0.05). The prevalence of non-white race, pre-transplant dialysis and a previous transplant did not differ significantly by eGFR (all p>0.13).

Both lower eGFR and greater UPr:Cr independently predicted death or graft failure. Greater UPr:Cr was strongly associated with risk overall and in each category of eGFR, whereas eGFR was associated with risk overall and in all but one UPr:Cr category. There was no significant interaction between eGFR and UPr:Cr (p=0.33). Results were similar for death and death-censored graft failure.

CKD stage, defined by both eGFR and UPr:Cr, provides independent prognostic information in kidney transplant recipients.

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