The risk of mortality and graft loss is higher in kidney transplant recipients with reduced estimated glomerular filtration rate (eGFR) and heavier albuminuria. It is unclear whether these markers are also associated with post-transplant cardiovascular events. In the current study, we describe the relationship between categories of 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 adverse cardiovascular events. We used linked healthcare databases in Alberta, Canada to retrospectively follow kidney transplant recipients from 2002-2011. There were 900 recipients with a functioning graft and at least 1 outpatient serum creatinine and urine albumin measurement at 1-year post-transplant. Median age was 51.2 years, 38.7% were female, and 52.0% had eGFR ≥60 mL/min/1.73 m². The median follow-up was 5.1 years. Across each category of eGFR, the adjusted risk of death-censored cardiovascular events (a composite of myocardial infarction, coronary intervention or bypass surgery, ischemic stroke, or heart failure) increased in recipients with heavier albuminuria. The adjusted incidence rate per 1000 person-years for recipients with eGFR 15-29 mL/min/1.73 m² and heavy albuminuria vs. eGFR >60 mL/min/1.73 m² and normal albumin excretion was 108.0 (95% CI 33.4-262.7) vs. 32.6 (95% CI 23.2-45.3) (rate ratio 3.3, 95% CI 1.6-7.1). These findings suggest that eGFR and albuminuria can be used together to risk stratify transplant recipients for adverse cardiovascular outcomes.

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

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