Prevalence and progression of chronic kidney disease after renal transplantation

Background

We studied the prevalence of chronic kidney disease (CKD) and its progression after kidney transplantation.

Methods

We retrospectively analyzed the evolution of renal graft function, as estimated by the Cockcroft-Gault equation in 567 patients. CKD was classified in accordance with the National Kidney Foundation/Kidney Disease Outcome Quality Initiative with progression estimated by calculating the slope over time.

Results

Creatinine clearance (CrCL) at 1 year after transplantation was 57.8 ± 15.5 mL/min with 61.9% patients presenting de novo chronic renal failure. The 1-year-CrCl provided the best correlation with the 3-year CrCl (R² = 0.58; P < .001). Medians of slope (MS) among all patients was −2.38 ± 5.7 mL/min/y (−11.9 mL/min over 5 years). Patients who reached a CrCl < 60 at 1 year after transplantation showed a MS of −3.92 ± 6.5, while the others, −2.03 ± 5.2 mL/min/y (P = .046). Similarly, patients who reached a CrCL < 60 at 3 years after transplantation displayed a MS of −1.49 ± 3.5 mL/min/y, while the others, 0.62 ± 3.0 mL/min/y (P < .001).

Conclusions

The majority of renal transplant patients present de novo chronic renal failure already at 1 year posttransplantation. The rate of graft functional deterioration was 2.38 mL/min/y. It was worse among patients who displayed a CrCL less than 60 mL/min both at 1 and at 3 years. One-year CrCL was a good marker for 3-year CrCL.