The negative impact of serum uric acid (UA) on the function of transplanted kidneys is still being investigated. We aimed to evaluate the predictive value of uric acid (UA) levels and its association with immunosuppressive (IS) drug regimens during the first year posttransplant for graft function.

Our study included 200 renal allograft recipients transplanted from living donors between October 2010 and November 2011 and followed for nearly two years (18.3 ± 2.9 months). Data on UA, estimated glomerular filtration rate (eGFR), proteinuria, IS and antihypertensive therapies at 3, 6 and 12 months were collected.

A triple IS therapy including calcineurin inhibitor (CNI), mycophenoloic acid (MPA) and steroid was started for all patients. CNI was switched to mammalian target of rapamycin (mTOR) inhibitor after 3-6 months in 50 of them (Group I) while 150 patients (Group II) continued on the standard protocol. Analysis of the data was interpreted by using Cox proportional hazard models and generalized estimating equations. No differences in age, gender, duration of pretransplant dialysis, number of HLA mismatches, or body mass index existed between the groups. The prevalence of diabetic, ischemic, or hypertensive nephropathy as the etiology for end-stage renal disease was similar. Blood pressure was strictly controlled. No graft loss was observed in either group, however mean UA level was significantly low in Group I patients (p=0.02) and UA interacted with eGFR (HR: 0.993, p < 0.05). At the end of the second year urine protein-creatinine ratio regarding graft dysfunction, was higher in group II despite the decrease in GFR.

Besides their positive effects on glomerular hemodynamics, association of low UA and proteinuria levels with better eGFR may favor the choice of mTOR inhibitors already known for less nephrotoxicity.

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