Limits...
Serum Uric Acid and Renal Transplantation Outcomes: At Least 3-Year Post-transplant Retrospective Multivariate Analysis.

Zhang K, Gao B, Wang Y, Wang G, Wang W, Zhu Y, Yao L, Gu Y, Chen M, Zhou H, Fu Y - PLoS ONE (2015)

Bottom Line: Uric acid level is proven to be negatively associated with eGFR at different time point after adjustment for age, body mass index and male gender (standardized β ranges from -0.15 to -0.30 with all P<0.001).Males with low eGFR but high level of TG were on CSA, diuretics and RAS inhibitors and experienced at least one episode of acute rejection and diabetic issue were associated with a higher mean uric acid level.Hyperuricemia was significantly an independent predictor of pure graft failure (hazard ratio=4.01, 95% CI: 1.25-12.91, P=0.02) after adjustment.Together with the high TG level impact on poor outcomes, further investigations for therapeutic effect are needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China.

ABSTRACT
Since the association of serum uric acid and kidney transplant graft outcome remains disputable, we sought to evaluate the predictive value of uric acid level for graft survival/function and the factors could affect uric acid as time varies. A consecutive cohort of five hundred and seventy three recipients transplanted during January 2008 to December 2011 were recruited. Data and laboratory values of our interest were collected at 1, 3, 6, 12, 24 and 36 months post-transplant for analysis. Cox proportional hazard model, and multiple regression equation were built to adjust for the possible confounding variables and meet our goals as appropriate. The current cohort study lasts for 41.86 ± 15.49 months. Uric acid level is proven to be negatively associated with eGFR at different time point after adjustment for age, body mass index and male gender (standardized β ranges from -0.15 to -0.30 with all P<0.001).Males with low eGFR but high level of TG were on CSA, diuretics and RAS inhibitors and experienced at least one episode of acute rejection and diabetic issue were associated with a higher mean uric acid level. Hyperuricemia was significantly an independent predictor of pure graft failure (hazard ratio=4.01, 95% CI: 1.25-12.91, P=0.02) after adjustment. But it was no longer an independent risk factor for graft loss after adjustment. Interestingly, higher triglyceride level can make incidence of graft loss (hazard ratio=1.442, for each unit increase millimoles per liter 95% CI: 1.008-2.061, P=0.045) and death (hazard ratio=1.717, 95% CI: 1.105-2.665, P=0.016) more likely. The results of our study suggest that post-transplant elevated serum uric acid level is an independent predictor of long-term graft survival and graft function. Together with the high TG level impact on poor outcomes, further investigations for therapeutic effect are needed.

No MeSH data available.


Related in: MedlinePlus

1-month post-transplant eGFRs and UAs for patients of different outcomes.Every single dot represents for either an eGFR or a UA value. Green dots are plotted on left y axis and red dots are on right y axis. (A) It indicates the group of patients without bad outcomes. (B) Patients suffered allograft failure or dead eventually. (C) Patients only suffered allograft failure. (D) Patients dead with functioning graft.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4514650&req=5

pone.0133834.g002: 1-month post-transplant eGFRs and UAs for patients of different outcomes.Every single dot represents for either an eGFR or a UA value. Green dots are plotted on left y axis and red dots are on right y axis. (A) It indicates the group of patients without bad outcomes. (B) Patients suffered allograft failure or dead eventually. (C) Patients only suffered allograft failure. (D) Patients dead with functioning graft.

Mentions: Early post-transplant outcome is also our concern when we initiated this proposition. Because the early post-transplant outcomes may determine the long-term outcomes. Therefore we need to distinguish different long-term prognosis groups as shown on Table 6 and Fig 2 to eliminate the bias caused by the early post-transplant outcomes. The graft loss patients have a 74.85 ± 30.44 eGFR level which is lower than patients without bad outcomes 86.65 ± 26.63 (P = 0.026). So does pure graft loss group when compared to normal recipients (69.0 ± 36.5 VS 86.65 ± 26.63, P = 0.006). These two groups have significantly lower mean eGFR mostly due to 5 special patients whose eGFR level were incredibly low (all eGFRs<10, 1 was having an acute rejection when tested for eGFR, the other 4 patients were experiencing DGF, 2 of them returned to dialysis eventually and the other 2 had recovered 2 months later). By excluding these 5 patients, mean eGFR and uric acid level of both groups are equally comparable with nice prognosis group (Table 7 and Fig 3).


Serum Uric Acid and Renal Transplantation Outcomes: At Least 3-Year Post-transplant Retrospective Multivariate Analysis.

Zhang K, Gao B, Wang Y, Wang G, Wang W, Zhu Y, Yao L, Gu Y, Chen M, Zhou H, Fu Y - PLoS ONE (2015)

1-month post-transplant eGFRs and UAs for patients of different outcomes.Every single dot represents for either an eGFR or a UA value. Green dots are plotted on left y axis and red dots are on right y axis. (A) It indicates the group of patients without bad outcomes. (B) Patients suffered allograft failure or dead eventually. (C) Patients only suffered allograft failure. (D) Patients dead with functioning graft.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4514650&req=5

pone.0133834.g002: 1-month post-transplant eGFRs and UAs for patients of different outcomes.Every single dot represents for either an eGFR or a UA value. Green dots are plotted on left y axis and red dots are on right y axis. (A) It indicates the group of patients without bad outcomes. (B) Patients suffered allograft failure or dead eventually. (C) Patients only suffered allograft failure. (D) Patients dead with functioning graft.
Mentions: Early post-transplant outcome is also our concern when we initiated this proposition. Because the early post-transplant outcomes may determine the long-term outcomes. Therefore we need to distinguish different long-term prognosis groups as shown on Table 6 and Fig 2 to eliminate the bias caused by the early post-transplant outcomes. The graft loss patients have a 74.85 ± 30.44 eGFR level which is lower than patients without bad outcomes 86.65 ± 26.63 (P = 0.026). So does pure graft loss group when compared to normal recipients (69.0 ± 36.5 VS 86.65 ± 26.63, P = 0.006). These two groups have significantly lower mean eGFR mostly due to 5 special patients whose eGFR level were incredibly low (all eGFRs<10, 1 was having an acute rejection when tested for eGFR, the other 4 patients were experiencing DGF, 2 of them returned to dialysis eventually and the other 2 had recovered 2 months later). By excluding these 5 patients, mean eGFR and uric acid level of both groups are equally comparable with nice prognosis group (Table 7 and Fig 3).

Bottom Line: Uric acid level is proven to be negatively associated with eGFR at different time point after adjustment for age, body mass index and male gender (standardized β ranges from -0.15 to -0.30 with all P<0.001).Males with low eGFR but high level of TG were on CSA, diuretics and RAS inhibitors and experienced at least one episode of acute rejection and diabetic issue were associated with a higher mean uric acid level.Hyperuricemia was significantly an independent predictor of pure graft failure (hazard ratio=4.01, 95% CI: 1.25-12.91, P=0.02) after adjustment.Together with the high TG level impact on poor outcomes, further investigations for therapeutic effect are needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China.

ABSTRACT
Since the association of serum uric acid and kidney transplant graft outcome remains disputable, we sought to evaluate the predictive value of uric acid level for graft survival/function and the factors could affect uric acid as time varies. A consecutive cohort of five hundred and seventy three recipients transplanted during January 2008 to December 2011 were recruited. Data and laboratory values of our interest were collected at 1, 3, 6, 12, 24 and 36 months post-transplant for analysis. Cox proportional hazard model, and multiple regression equation were built to adjust for the possible confounding variables and meet our goals as appropriate. The current cohort study lasts for 41.86 ± 15.49 months. Uric acid level is proven to be negatively associated with eGFR at different time point after adjustment for age, body mass index and male gender (standardized β ranges from -0.15 to -0.30 with all P<0.001).Males with low eGFR but high level of TG were on CSA, diuretics and RAS inhibitors and experienced at least one episode of acute rejection and diabetic issue were associated with a higher mean uric acid level. Hyperuricemia was significantly an independent predictor of pure graft failure (hazard ratio=4.01, 95% CI: 1.25-12.91, P=0.02) after adjustment. But it was no longer an independent risk factor for graft loss after adjustment. Interestingly, higher triglyceride level can make incidence of graft loss (hazard ratio=1.442, for each unit increase millimoles per liter 95% CI: 1.008-2.061, P=0.045) and death (hazard ratio=1.717, 95% CI: 1.105-2.665, P=0.016) more likely. The results of our study suggest that post-transplant elevated serum uric acid level is an independent predictor of long-term graft survival and graft function. Together with the high TG level impact on poor outcomes, further investigations for therapeutic effect are needed.

No MeSH data available.


Related in: MedlinePlus