The 2002 NKF-K/DOQI Chronic Kidney Disease (CKD) classification scheme, based largely on the estimated glomerular filtration rate (eGFR), has been criticized for failing to adequately reflect prognosis. The KDIGO consortium has recently proposed some modifications to the original scheme with subdivision of stage 3 CKD into two sub-stages and incorporation of a measure of proteinuria (urinary albumin to creatinine ratio, ACR). The purpose of this study was to evaluate whether the novel scheme provided graded risk in a kidney transplant population. Graft failure, patient death, cardiovascular events and doubling of serum creatinine were extracted from the medical records of kidney transplant recipients who had previously participated in a GFR measurement study and had ^99mTc-DTPA GFR, serum creatinine and ACR measurement performed on the same day. Patients were stratified according to the new classification scheme using the CKD-EPI equation and the proportion of patients who experienced an event in each CKD catergory was calculated. There were 207 patients in total with a mean length of follow-up of 6.4 ± 0.8 years. The number of patients in GFR stages 1, 2, 3a, 3b, 4 and 5 were 11, 67, 59, 47, 19 and 4. Thirty-two (20%) experienced the combined outcome of death or graft loss. The proportion of patients in each risk category who developed the combined outcome of death and graft loss is presented below.

The novel classification scheme based on CKD-EPI eGFR and ACR does provide graded risk for adverse outcomes in kidney transplant recipients. Similar findings were found for the outcomes of doubling of the serum creatinine and cardiovascular events.

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