1
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Imasuen UJ, Swanson KJ, Parajuli S. Serum uric acid levels in kidney transplant recipients: A cause for concern? A review of recent literature. Transplant Rev (Orlando) 2023; 37:100775. [PMID: 37437509 DOI: 10.1016/j.trre.2023.100775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
The impact of elevated serum uric acid levels i.e., hyperuricemia, on native and transplant chronic kidney disease progression has been debated. This literature review presents an analysis of multiple studies exploring the relationship between serum uric acid levels and kidney transplant outcomes. The review includes a summary of the pathophysiology of hyperuricemia and gout, a review of urate-lowering therapies, and an appraisal of multiple studies examining the association or lack thereof between serum uric acid level and kidney transplant outcomes. Based on these studies, elevated serum uric acid levels may contribute to CKD progression in kidney transplant recipients. In this review, we also summarize current literature to highlight risk factors associated with hyperuricemia as well as the need for further investigation to monitor and manage hyperuricemia in kidney transplant recipients.
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Affiliation(s)
- Uyi Jefferson Imasuen
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Kurtis J Swanson
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America.
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Zhang F, Liang J, Xiong Y, Zhang F, Wu K, Wang W, Yuan J, Lin T, Wang X. Serum uric acid as a risk factor for rejection after deceased donor kidney transplantation: A mono-institutional analysis of paired kidneys. Front Immunol 2022; 13:973425. [PMID: 36578496 PMCID: PMC9791182 DOI: 10.3389/fimmu.2022.973425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Background Deceased donor kidney transplantation (DDKT) is a major therapeutic option for patients with end-stage renal diseases. Although medical techniques improved in recent years, acute or chronic rejection after DDKT is not uncommon and often results in poor graft survival. Therefore, the determination of risk factors is very important to stratify patients and to improve outcomes. This study aims to evaluate the risk factors for treated rejection (TR) of patients after DDKT. Methods Clinical data of deceased donors and corresponding recipients were retrospectively collected. The primary outcome was TR defined as the treatment for rejection within 24 months after DDKT. Univariate comparisons of baseline characteristics were performed with Chi-square test, t-test, and Mann-Whitney U test. Logistic regression was constructed to analyze potential risk factors. Receiver operating characteristic (ROC) curve and Jordan index were generated to determine the optimal cutoff value. The association between continuous variables and TR was examined and visualized by using restricted cubic spline (RCS) models. Results Data of 123 deceased donors and 246 recipients were obtained and analyzed. The median age was 41 (4-62) years for recipients and 39 (1-65) years for donors. The recipients who died or suffered graft loss during the follow-up period were 8 (3.3%) and 12 (4.9%), respectively. After univariate analysis and subsequent multivariate analysis, the preoperative serum uric acid (OR, 2.242; 95% CI, 1.037-4.844; P = 0.040), platelet (OR, 2.163; 95% CI, 1.073-4.361, P = 0.031), absolute neutrophil count (OR, 2.183; 95% CI, 1.025-4.649; P = 0.043), and HLA-DQ mismatch (OR, 2.102; 95% CI, 1.093-4.043; P = 0.026) showed statistical significance. RCS models showed that patients with higher levels of uric acid had increased risk of TR. Conclusions Serum uric acid and other three indicators were found to be the independent risk factors for TR, which may contribute to stratify patients and develop personalized regimen in perioperative period.
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Prytula A, Shroff R, Krupka K, Deschepper E, Bacchetta J, Ariceta G, Awan A, Benetti E, Büscher A, Berta L, Carraro A, Christian M, Dello Strologo L, Doerry K, Haumann S, Klaus G, Kempf C, Kranz B, Oh J, Pape L, Pohl M, Printza N, Rubik J, Schmitt CP, Shenoy M, Spartà G, Staude H, Sweeney C, Weber L, Weber S, Weitz M, Haffner D, Tönshoff B. Hyperparathyroidism Is an Independent Risk Factor for Allograft Dysfunction in Pediatric Kidney Transplantation. Kidney Int Rep 2022; 8:81-90. [PMID: 36644359 PMCID: PMC9832060 DOI: 10.1016/j.ekir.2022.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/15/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Little is known about the consequences of deranged chronic kidney disease-mineral and bone disorder (CKD-MBD) parameters on kidney allograft function in children. We examined a relationship between these parameters over time and allograft outcome. Methods This registry study from the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) collected data at baseline, months 1, 3, 6, 9, and 12 after transplant; and every 6 months thereafter up to 5 years. Survival analysis for a composite end point of graft loss or estimated glomerular filtration rate (eGFR) ≤30 ml/min per 1.73 m2 or a ≥50% decline from eGFR at month 1 posttransplant was performed. Associations of parathyroid hormone (PTH), calcium, phosphate, and 25-hydroxyvitamin D (25(OH)D) with allograft outcome were investigated using conventional stratified Cox proportional hazards models and further verified with marginal structural models with time-varying covariates. Results We report on 1210 patients (61% boys) from 16 European countries. The composite end point was reached in 250 grafts (21%), of which 11 (4%) were allograft losses. In the conventional Cox proportional hazards models adjusted for potential confounders, only hyperparathyroidism (hazard ratio [HR], 2.94; 95% confidence interval [CI], 1.82-4.74) and hyperphosphatemia (HR, 1.94; 95% CI, 1.28-2.92) were associated with the composite end point. Marginal structural models showed similar results for hyperparathyroidism (HR, 2.74; 95% CI, 1.71-4.38), whereas hyperphosphatemia was no longer significant (HR, 1.35; 95% CI, 0.87-2.09), suggesting that its association with graft dysfunction can be ascribed to a decline in eGFR. Conclusion Hyperparathyroidism is a potential independent risk factor for allograft dysfunction in children.
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Affiliation(s)
- Agnieszka Prytula
- Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium
- Correspondence: Agnieszka Prytula, Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium.
| | - Rukshana Shroff
- Renal Unit, University College London Great Ormond Street Hospital, London, United Kingdom
| | - Kai Krupka
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Justine Bacchetta
- Reference Center for Rare Renal Diseases, Reference Center for Rare Diseases of Calcium and Phosphate Metabolism, Hospices Civils de Lyon, France
| | - Gema Ariceta
- Pediatric Nephrology. University Hospital Vall d’ Hebron, Barcelona, Spain
| | - Atif Awan
- Department of Nephrology and Transplantation, Temple Street, Dublin, Ireland
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women’s and Children’s Health, Padua University Hospital, Padua, Italy
| | - Anja Büscher
- Department of Pediatrics II, University Hospital of Essen, Essen, Germany
| | - László Berta
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Andrea Carraro
- Pediatric Nephrology, Dialysis and Transplant Unit, Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women’s and Children’s Health, Padua University Hospital, Padua, Italy
| | | | - Luca Dello Strologo
- Renal Transplant Unit, Bambino Gesù Children’s Research Hospital Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Katja Doerry
- Department of Pediatric Nephrology and Transplantation, University Children’s Hospital, University Medical Center Hamburg/Eppendorf, Hamburg, Germany
| | - Sophie Haumann
- Pediatric Nephrology, Children’s and Adolescents’ Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Guenter Klaus
- KfH-Pediatric Kidney Center and Department of Pediatrics, Philipps-University of Marburg, Marburg, Germany
| | - Caroline Kempf
- Department of Pediatric Gastroenterology, Nephrology and Metabolism, Charité–University Medicine Berlin, Berlin, Germany
| | | | - Jun Oh
- Department of Pediatric Nephrology and Transplantation, University Children’s Hospital, University Medical Center Hamburg/Eppendorf, Hamburg, Germany
| | - Lars Pape
- Department of Pediatrics II, University Hospital of Essen, Essen, Germany
| | - Martin Pohl
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nikoleta Printza
- Pediatric Nephrology Unit, Pediatric Department I, Hippokration General Hospital, Aristotle University, Thessaloniki, Greece
| | - Jacek Rubik
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, Children’s Memorial Health Institute, Warsaw, Poland
| | - Claus Peter Schmitt
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Mohan Shenoy
- Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Giuseppina Spartà
- Department of Pediatric Nephrology, University Children’s Hospital Zurich, Zurich, Switzerland
| | | | - Clodagh Sweeney
- Department of Nephrology and Transplantation, Temple Street, Dublin, Ireland
| | - Lutz Weber
- Pediatric Nephrology, Children’s and Adolescents’ Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Stefanie Weber
- KfH-Pediatric Kidney Center and Department of Pediatrics, Philipps-University of Marburg, Marburg, Germany
| | - Marcus Weitz
- Department of General Pediatrics and Hematology/Oncology, University Children’s Hospital Tuebingen, Tuebingen, Germany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
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Ibrahim HN, Murad DN, Knoll GA. Thinking Outside the Box: Novel Kidney Protective Strategies in Kidney Transplantation. Clin J Am Soc Nephrol 2021; 16:1890-1897. [PMID: 33757985 PMCID: PMC8729499 DOI: 10.2215/cjn.15070920] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Despite the reduction in the incidence of acute rejection, a major risk factor for graft loss, there has been only modest improvement in long-term graft survival. Most cases of kidney graft loss have an identifiable cause that is not idiopathic fibrosis/atrophy or calcineurin inhibitor nephrotoxicity. Distinct immunologic and nonimmunologic factors conspire to lead to a common pathway of allograft fibrosis. It remains plausible that mitigating nonimmunologic damage using strategies proven effective in native kidney disease may yield benefit in kidney transplantation. In this review, we will focus on nonimmunologic aspects of kidney transplant care that may prove to be valuable adjuncts to a well-managed immunosuppression regimen. Topics to be addressed include the roles of hypertension and agents used to treat it, lipid lowering, sodium and water intake, elevated uric acid, metabolic acidosis, and the use of sodium-glucose cotransporter 2 inhibitors on long-term kidney transplant health.
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Affiliation(s)
- Hassan N. Ibrahim
- Division of Renal Diseases and Hypertension, Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Dina N. Murad
- Division of Renal Diseases and Hypertension, Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Greg A. Knoll
- Division of Nephrology, Department of Medicine, Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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5
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Isakov O, Patibandla BK, Shwartz D, Mor E, Christopher KB, Hod T. Can uric acid blood levels in renal transplant recipients predict allograft outcome? Ren Fail 2021; 43:1240-1249. [PMID: 34433378 PMCID: PMC8405090 DOI: 10.1080/0886022x.2021.1969246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Hyperuricemia is common after renal transplantation, especially in those receiving calcineurin inhibitors. Little, however, is known about the relationship between uric acid (UA) levels and allograft outcome. Methods We conducted a retrospective single-center analysis (N = 368) in order to assess UA blood levels post-transplant association with allograft outcome. For this study, a median serum UA level of all measured UA levels from 1 month to 1 year post renal transplantation was calculated. Results Patients were divided into 2 groups based on the median UA level measured between 1 and 12 months post-transplant. Those with median UA level ≥ 7 and ≥ 6 mg/dL (N = 164) versus median UA level < 7 and < 6 mg/dL for men and women respectively (N = 204) had lower GFR values at 1, 3 and 5 years posttransplant (mean GFR ± SD of 43.4 ± 20.6 and 58 ± 19.9 at 3 years post-transplant, p < 0.001). In multivariate models, UA levels were no longer significantly associated with renal allograft function. In a multivariate cox proportional hazard model, UA level was found to be independently associated with increased risk for death-censored graft loss (HR of 1.3, 95% CI 1.0–1.7, p < 0.05 for every increase of 1 mg/dL in UA level). Conclusion Hyperuricemia was found to be associated with increased death- censored graft loss but not with allograft function. Increased UA levels were not found to be an independent predictor of long-term allograft function despite the known association of hyperuricemia with the progression of cardiovascular and renal disease.
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Affiliation(s)
- Ofer Isakov
- Department of Internal Medicine "T", Tel Aviv Souraski Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Bhanu K Patibandla
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Doron Shwartz
- Department of Nephrology, Souraski Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Eytan Mor
- Renal Transplant Center, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Kenneth B Christopher
- Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Tammy Hod
- Renal Transplant Center, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
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New-Onset Gout as an Independent Risk Factor for Returning to Dialysis After Kidney Transplantation. Transplant Direct 2020; 6:e634. [PMID: 33225059 PMCID: PMC7673774 DOI: 10.1097/txd.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/13/2020] [Indexed: 11/25/2022] Open
Abstract
Background. The causal relationship between gout and renal transplant outcomes is difficult to assess due to multiple interacting covariates. This study sought to estimate the independent effect of new-onset gout on renal transplant outcomes using a methodology that accounted for these interactions. Methods. This study analyzed data on patients in the US Renal Data System (USRDS) who received a primary kidney transplant between 2008 and 2015. The exposure was new-onset gout, and the primary endpoint was returning to dialysis >12 months postindex date (transplant date). A marginal structural model (MSM) was fitted to determine the relative risk of new-onset gout on return to dialysis. Results. 18 525 kidney transplant recipients in the USRDS met study eligibility. One thousand three hundred ninety-nine (7.6%) patients developed new-onset gout, and 1420 (7.7%) returned to dialysis >12 months postindex. Adjusting for baseline and time-varying confounders via the MSM showed new-onset gout was associated with a 51% increased risk of return to (RR, 1.51; 95% CI, 1.03-2.20). Conclusions. This finding suggests that new onset gout after kidney transplantation could be a harbinger for poor renal outcomes, and to our knowledge is the first study of kidney transplant outcomes using a technique that accounted for the dynamic relationship between renal dysfunction and gout.
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7
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Li JW, Suh M, Brigham MD, Kent JD, LaMoreaux B, Johnson RJ, Mandell BF, Hadker N, Sanchez H, Francis K, Miyasato G. A Retrospective Cohort Study of the Effect of Gout on Mortality Among Patients with a History of Kidney Transplantation. Ann Transplant 2020; 25:e920553. [PMID: 32284525 PMCID: PMC7177036 DOI: 10.12659/aot.920553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Kidney transplantation is associated with increased prevalence of gout. However, evidence of the effect of gout on long-term kidney transplantation outcomes is mixed. This study examined mortality risk among patients with a history of kidney transplantation with vs. without gout. Material/Methods A retrospective study was conducted using Medicare Fee-for-Service administrative claims of patients with a history of kidney transplantation. Cox proportional hazards models determined the effect of gout on all-cause mortality, controlling for confounders, including comorbid mortality risk, via the Charlson Comorbidity Index. Because the relationships between gout and components of the Charlson Comorbidity Index are also debated, 3 different model assumptions were used: 1) gout shares a common cause with these comorbidities, 2) gout is upstream of these comorbidities, 3) the effect of gout on mortality is modified by these comorbidities. Results Gout increased the risk of all-cause mortality in the unadjusted model (hazard ratio: 1.44, 95% CI 1.27–1.63) and after adjustment for demographics and transplant vintage (hazard ratio: 1.16, 95% CI 1.02–1.32). Gout was not a significant risk after adjustment for baseline Charlson Comorbidity Index (hazard ratio: 1.03, 95% CI 0.90–1.17). Gout was associated with greater mortality among patients without baseline comorbidities (Charlson Comorbidity Index=0; hazard ratio: 3.48, 95% CI 1.27–9.57) in the stratified model. Conclusions Among patients with a history of kidney transplantation, gout did not have an independent effect on all-cause mortality. However, gout was a predictor of mortality among patients with no comorbidities, suggesting that gout is an early warning sign of poor health in kidney transplantation patients.
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Affiliation(s)
| | | | | | - Jeffrey D Kent
- Medical Affairs, Horizon Pharma USA Inc., Lake Forest, IL, USA
| | - Brian LaMoreaux
- Medical Affairs, Horizon Pharma USA Inc., Lake Forest, IL, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA
| | - Brian F Mandell
- Division of Rheumatology, Cleveland Clinic, Cleveland, OH, USA
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Chen L, Bai H, Jin H, Zhang T, Shi B, Cai M, Wang Y. Outcomes in kidney transplantation with mycophenolate mofetil-based maintenance immunosuppression in China: a large-sample retrospective analysis of a national database. Transpl Int 2020; 33:718-728. [PMID: 31868986 DOI: 10.1111/tri.13566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/27/2019] [Accepted: 12/18/2019] [Indexed: 11/30/2022]
Abstract
There is no large data analysis reporting the outcome of Chinese kidney transplant patients using mycophenolate mofetil (MMF). This study analyzed 6719 patients from the Chinese Scientific Registry of Kidney Transplantation using MMF, which included 1153 from donation after cardiac death (DCD), 1271 from donation after brain and cardiac death (DBCD), and 4295 from living donor (LD). Compared with the transplants from deceased donor (DD), better outcomes including 3-year graft survival probabilities (LD = 95.8% vs. DD = 91.3%), incidence of delayed graft function (DGF, LD = 2.4% vs. DD = 17.7%), infection (LD = 10.7% vs. DD = 20.7%), graft loss (LD = 2.3% vs. DD = 6.3), and death (LD = 1.3% vs. DD = 3.2%) were shown in the LD group, with similar incidences of acute rejection (AR, LD = 3.7% vs. DD = 4.7%), hyperuricemia (LD = 21.7% vs. DD = 22.2%) within postoperative 1 year, and serum creatinine (Scr) >133 μmol/l at 1 year (LD = 18.8% vs. DD = 18.6%). Nonsignificant differences were found between the DCD and DBCD group. The 5-year survival of patient and graft in the LD group were 97.5% and 93.0%. Adjusted Cox model for graft loss showed significant associations with DGF [hazard ratio 3.7 (95% CI: 2.4, 5.8)], AR [2.8 (1.7, 4.6)], Scr >133 μmol/l at 1 year [2.6 (1.5, 4.2)], hyperuricemia [2.3 (1.6, 3.3)], and DD [1.6 (1.1, 2.4)].
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Affiliation(s)
- Liping Chen
- Kidney Transplant Quality Control Center of National Health Commission, The 8th Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hongwei Bai
- Kidney Transplant Quality Control Center of National Health Commission, The 8th Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hailong Jin
- Kidney Transplant Quality Control Center of National Health Commission, The 8th Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Tianyu Zhang
- Kidney Transplant Quality Control Center of National Health Commission, The 8th Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Bingyi Shi
- Kidney Transplant Quality Control Center of National Health Commission, The 8th Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ming Cai
- Kidney Transplant Quality Control Center of National Health Commission, The 8th Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yudi Wang
- Kidney Transplant Quality Control Center of National Health Commission, The 8th Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
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Kitamura M, Mochizuki Y, Matsuda T, Mukae Y, Nakanishi H, Ota Y, Uramatsu T, Obata Y, Sakai H, Mukae H, Nishino T. Sex differences in uric acid levels in kidney transplant recipients and their donors: a preliminary retrospective cross-sectional study. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Higher serum uric acid (UA) levels are associated with poorer renal prognosis. In kidney transplantation, both donors and recipients are diagnosed as having chronic kidney diseases (CKD) based on renal function; however, their UA levels slightly vary. Elucidating the differences in UA would help improve kidney prognosis, especially for recipients. Therefore, we investigated UA levels in kidney transplant recipients by comparing them to those in their donors.
Methods
In this retrospective cross-sectional survey, background information and blood examination results were collected from the donors just before donation and after transplantation in the donors and recipients. Associations between UA and sex estimated glomerular filtration rate (eGFR), and body mass index (BMI) were evaluated. Data were assessed by the Wilcoxon rank-sum test for continuous variables and the chi-squared test for categorical variables; multiple linear regression analyses were performed to determine which factors were associated with renal function before and after transplantation.
Results
Participant characteristics were as follows. The mean donor age (n = 45, 16 men and 29 women) was 55 ± 11 years, and the mean recipient age (n = 45, 25 men and 20 women) was 46 ± 16 years. Sex-related differences (UA levels in men were predominant) existed in the UA of donors before (P < 0.001) and after donation (P < 0.001). Conversely, there were no significant sex-related differences in the UA of recipients (P = 0.51); the mean standardized eGFRs were similar in donors and recipients after transplantation. Multivariate linear regression analysis showed donor UA only correlated with donor sex before donation (P = 0.008). After donation, donor UA was associated with donor sex (P = 0.006), eGFR (P < 0.001), and BMI (P = 0.02). Notably, the UA of recipients after transplantation was only associated with eGFR (P = 0.003).
Conclusions
Sex has less impact on UA in recipients than in donors. UA has a greater impact on renal prognosis in women than men, even at the same UA level. Therefore, attention should be given to UA levels in female recipients. These findings can be useful for determining patient prognosis following kidney transplantation in both donors and recipients.
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Brigham MD, Milgroom A, Lenco MO, Tudor T, Kent JD, LaMoreaux B, Johnson RJ, Mandell BF, Hadker N, Francis K, Sanchez H, Radeck LP, Li JW. Prevalence of Gout in the Surviving United States Solid Organ Transplantation Population. Transplant Proc 2019; 51:3449-3455. [PMID: 31733798 DOI: 10.1016/j.transproceed.2019.08.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/30/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Although incidence and survival are frequent topics within the solid organ transplantation (SOT) literature, the size of the surviving SOT population is not well known. Existing studies of gout in patients with SOT have focused on the incident SOT population. This analysis was performed to characterize the prevalent SOT population and the prevalence of gout within it. METHODS This study includes the 2017 United States (US) population size of recipients of kidney, heart, liver, and lung transplants that was estimated by combining primary transplant recipient cohort sizes (1988-2017) with previously published survival rates for each annual cohort's time since transplantation (0-29 years). Gout among prevalent patients with SOT was assessed using Medicare and commercial claims. RESULTS A total of 637,231 US patients received a primary kidney (393,953), liver (142,186), heart (66,637), or lung (34,455) transplant between 1988 and 2017. An estimated 356,000 (55.8%) recipients were alive in 2017 (233,000 kidney; 78,700 liver; 29,300 heart; 14,700 lung). Gout was identified in 11% of prevalent patients with SOT in 2016. Higher rates of gout were seen in recipients of kidney (13.1%) and heart (12.7%) compared to recipients of liver (6.7%) and lung (5.6%) (P < .0001 in both datasets). Active diagnosed gout prevalence in the US population without a SOT history was 1.1% in 2016. CONCLUSIONS Hundreds of thousands of US patients are living with a transplanted organ today and these numbers are likely to increase. In patients with SOT, gout is a frequent comorbidity of which physicians should be aware. This study suggests a markedly higher rate of gout among transplant recipients compared to the general US population.
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Affiliation(s)
- Mark D Brigham
- Trinity Partners LLC, Waltham, Massachusetts, United States
| | | | | | - Thilan Tudor
- Trinity Partners LLC, Waltham, Massachusetts, United States
| | - Jeffrey D Kent
- Horizon Pharma USA Inc, Medical Affairs, Lake Forest, Illinois, United States
| | - Brian LaMoreaux
- Horizon Pharma USA Inc, Medical Affairs, Lake Forest, Illinois, United States
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado, United States
| | | | - Nandini Hadker
- Trinity Partners LLC, Waltham, Massachusetts, United States
| | - Kevin Francis
- Trinity Partners LLC, Waltham, Massachusetts, United States
| | - Herman Sanchez
- Trinity Partners LLC, Waltham, Massachusetts, United States
| | | | - Justin W Li
- Trinity Partners LLC, Waltham, Massachusetts, United States.
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11
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Kim DG, Choi HY, Kim HY, Lee EJ, Huh KH, Kim MS, Nam CM, Kim BS, Kim YS. Association between post-transplant serum uric acid levels and kidney transplantation outcomes. PLoS One 2018; 13:e0209156. [PMID: 30550582 PMCID: PMC6294369 DOI: 10.1371/journal.pone.0209156] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/02/2018] [Indexed: 12/22/2022] Open
Abstract
Background Serum uric acid (UA) level has been reported to be associated with chronic allograft nephropathy and graft failure in patients who undergo kidney transplantation (KT). However, the role of serum UA level in renal graft survival remains controversial. Objective This study aimed to investigate the effect of mean serum UA level during two different post-KT periods on long-term renal graft outcomes in a large population cohort in which living donor KT prevails. Material and methods A retrospective cohort study was performed using KT data prospectively collected at a single institution. Patients (n = 2,993) were divided into low-, normal-, and high-UA groups according to the mean serum UA level within the first year (1-YR) and 1–5 years (5-YR) after transplantation. Results In the 1-YR Cox proportional hazards analysis, the low- and high-UA groups had a significantly decreased and increased risk, respectively, for overall graft failure (OGF), death-censored graft failure (DCGF), and composite event (return to dialysis, retransplantation, death from graft dysfunction, and 40% decline in estimated glomerular filtration rate) compared with the normal-UA group. Similarly, in the 5-YR analysis, the low-UA group had a significantly reduced risk of DCGF compared with the normal-UA group, whereas the high-UA group had a significantly increased risk of all three graft outcomes. In a marginal structural model, hyperuricemia had a significant causal effect on worsening graft outcomes, with consideration of all confounding variables (OGF: hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.33–3.78; DCGF: HR 2.38, 95% CI 1.09–4.9; composite event: HR 3.05, 95% CI 1.64–5.49). Conclusions A low-to-normal serum UA level within the first year and 1–5 years after KT is an independent factor for better renal allograft outcomes in the long-term follow-up period rather than high serum UA level.
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Affiliation(s)
- Deok Gie Kim
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Hoon Young Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ju Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyu Ha Huh
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, South Korea
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Myoung Soo Kim
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, South Korea
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Beom Seok Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail: (YSK); (BSK)
| | - Yu Seun Kim
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, South Korea
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail: (YSK); (BSK)
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12
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Association between post-transplant uric acid level and renal allograft fibrosis: Analysis using Banff pathologic scores from renal biopsies. Sci Rep 2018; 8:11601. [PMID: 30072753 PMCID: PMC6072792 DOI: 10.1038/s41598-018-29948-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022] Open
Abstract
Several experimental studies implicate uric acid in renal injury and fibrosis. The objective of this study was to examine the association between uric acid level and allograft fibrosis after kidney transplantation. 241 adult patients who underwent kidney transplantation between 2003 and 2014 were divided into three groups according to the sex specific tertiles of mean uric acid level within the first post-transplant year. The renal biopsies performed during 1 to 5 post-transplant year were analyzed to compare the degree of interstitial fibrosis and tubular atrophy (IF/TA). Mean interval between kidney transplantation and biopsy was similar between groups (23.7 ± 15.3 vs. 30.0 ± 18.6 vs. 27.5 ± 18.5 months, P = 0.072). The higher tertile uric acid level was, the more advanced grade of IF/TA was shown (P = 0.001). Multivariate analysis identified uric acid tertile was independent risk factor for severe IF/TA (odds ratio [95% confidence interval] was 3.16 [1.13-8.82] for tertile 2 and 3.70 [1.25-10.93] for tertile 3, versus tertile 1, respectively). Other independent factors were estimated glomerular filtration rate at 1year post-transplant (0.80 [CI 0.65-0.98]) and biopsy-proven rejection (2.34 [1.05-5.21]). Graft survival over 10 years was significantly lower in tertile 3 (P = 0.041). The results showed that higher uric acid level after kidney transplantation was associated with more severe IF/TA.
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13
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Eleftheriadis T, Pissas G, Sounidaki M, Antoniadi G, Antoniadis N, Liakopoulos V, Stefanidis I. Uric acid increases cellular and humoral alloimmunity in primary human peripheral blood mononuclear cells. Nephrology (Carlton) 2018; 23:610-615. [DOI: 10.1111/nep.13069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/10/2017] [Accepted: 04/30/2017] [Indexed: 12/19/2022]
Affiliation(s)
| | - Georgios Pissas
- Department of Nephrology, Faculty of Medicine; University of Thessaly; Larissa Greece
| | - Maria Sounidaki
- Department of Nephrology, Faculty of Medicine; University of Thessaly; Larissa Greece
| | - Georgia Antoniadi
- Department of Nephrology, Faculty of Medicine; University of Thessaly; Larissa Greece
| | - Nikolaos Antoniadis
- Organ Transplant Unit, Hippokration General Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Vassilios Liakopoulos
- Department of Nephrology, Faculty of Medicine; University of Thessaly; Larissa Greece
| | - Ioannis Stefanidis
- Department of Nephrology, Faculty of Medicine; University of Thessaly; Larissa Greece
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Kim SJ. Serum Uric Acid Levels and Kidney Transplant Outcomes: Cause, Consequence, or Confounded? Am J Kidney Dis 2017; 70:752-753. [DOI: 10.1053/j.ajkd.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/13/2017] [Indexed: 11/11/2022]
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15
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Kalil RS, Carpenter MA, Ivanova A, Gravens-Mueller L, John AA, Weir MR, Pesavento T, Bostom AG, Pfeffer MA, Hunsicker LG. Impact of Hyperuricemia on Long-term Outcomes of Kidney Transplantation: Analysis of the FAVORIT Study. Am J Kidney Dis 2017; 70:762-769. [DOI: 10.1053/j.ajkd.2017.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 06/04/2017] [Indexed: 02/07/2023]
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16
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Han M, Lee JP, Park S, Kim Y, Kim YC, Ahn C, Han DJ, Ha J, Jung IM, Lim CS, Kim YS, Kim YH, Oh YK. Early onset hyperuricemia is a prognostic marker for kidney graft failure: Propensity score matching analysis in a Korean multicenter cohort. PLoS One 2017; 12:e0176786. [PMID: 28467476 PMCID: PMC5415138 DOI: 10.1371/journal.pone.0176786] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/17/2017] [Indexed: 02/07/2023] Open
Abstract
It remains inconclusive whether hyperuricemia is a true risk factor for kidney graft failure. In the current study, we investigated the association of hyperuricemia and graft outcome. We performed a multi-center cohort study that included 2620 kidney transplant recipients. The patients were classified as either normouricemic or hyperuricemic at 3 months after transplantation. Hyperuricemia was defined as a serum uric acid level ≥ 7.0 mg/dL in males or ≥ 6.0 mg/dL in females or based on the use of urate-lowering medications. The two groups were compared before and after propensity score matching. A total of 657 (25.1%) patients were classified as hyperuricemic. The proportion of hyperuricemic patients increased over time, reaching 44.2% of the total cohort at 5 years after transplantation. Estimated glomerular filtration rate and donor type were independently associated with hyperuricemia. Hyperuricemia was associated with graft loss according to multiple Cox regression analysis before propensity score matching (hazard ratio [HR] = 1.56, 95% confidence interval [CI] = 1.14-2.13, P = 0.005) as well as after matching (HR = 1.65, 95% CI = 1.13-2.42, p = 0.010). Cox regression models using time-varying hyperuricemia or marginal structural models adjusted with time-varying eGFR also demonstrated significant hazards of hyperuricemia for graft loss. Cardiovascular events and recipient survival were not associated with hyperuricemia. Overall, hyperuricemia, especially early onset after transplantation, showed an increased risk for graft failure. Further studies are warranted to determine whether lowering serum uric acid levels would be beneficial to graft survival.
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Affiliation(s)
- Miyeun Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seokwoo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yunmi Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Duck Jong Han
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - In Mok Jung
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Kyu Oh
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
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17
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Park S, Kang E, Park S, Kim YC, Han SS, Ha J, Kim DK, Kim S, Park SK, Han DJ, Lim CS, Kim YS, Lee JP, Kim YH. Metabolic Acidosis and Long-Term Clinical Outcomes in Kidney Transplant Recipients. J Am Soc Nephrol 2016; 28:1886-1897. [PMID: 28031407 DOI: 10.1681/asn.2016070793] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/23/2016] [Indexed: 01/07/2023] Open
Abstract
Metabolic acidosis (MA), indicated by low serum total CO2 (TCO2) concentration, is a risk factor for mortality and progressive renal dysfunction in CKD. However, the long-term effects of MA on kidney transplant recipients (KTRs) are unclear. We conducted a multicenter retrospective cohort study of 2318 adult KTRs, from January 1, 1997 to March 31, 2015, to evaluate the prevalence of MA and the relationships between TCO2 concentration and clinical outcomes. The prevalence of low TCO2 concentration (<22 mmol/L) began to increase in KTRs with eGFR<60 ml/min per 1.73 m2 and ranged from approximately 30% to 70% in KTRs with eGFR<30 ml/min per 1.73 m2 Multivariable Cox proportional hazards models revealed that low TCO2 concentration 3 months after transplant associated with increased risk of graft loss (hazard ratio [HR], 1.74%; 95% confidence interval [95% CI], 1.26 to 2.42) and death-censored graft failure (DCGF) (HR, 1.66; 95% CI, 1.14 to 2.42). Cox regression models using time-varying TCO2 concentration additionally demonstrated significant associations between low TCO2 concentration and graft loss (HR, 3.48; 95% CI, 2.47 to 4.90), mortality (HR, 3.16; 95% CI, 1.77 to 5.62), and DCGF (HR, 3.17; 95% CI, 2.12 to 4.73). Marginal structural Cox models adjusted for time-varying eGFR further verified significant hazards of low TCO2 concentration for graft loss, mortality, and DCGF. In conclusion, MA was frequent in KTRs despite relatively preserved renal function and may be a significant risk factor for graft failure and patient mortality, even after adjusting for eGFR.
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Affiliation(s)
| | | | | | | | | | - Jongwon Ha
- Surgery, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | - Duck Jong Han
- Division of Kidney Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; and
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | | | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Hoon Kim
- Division of Kidney Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; and
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18
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Thomas B, Weir MR. The Evaluation and Therapeutic Management of Hypertension in the Transplant Patient. Curr Cardiol Rep 2015; 17:95. [DOI: 10.1007/s11886-015-0647-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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