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Osmoregulation Performance and Kidney Transplant Outcome.

ABSTRACT: BACKGROUND:Kidney transplant recipients have an impaired ability to dilute urine but seldom develop baseline hyponatremia before ESRD. Although hyponatremia is a risk factor for adverse events in CKD and in kidney transplant recipients, it remains unclear whether subtler alterations in osmoregulation performance are associated with outcome. METHODS:We studied a single-center prospective cohort of 1258 kidney transplant recipients who underwent a water-loading test 3 months after transplant to determine osmoregulation performance. Measured GFR (mGFR) was performed at the same visit. A group of 164 healthy candidates for kidney donation served as controls. We further evaluated the association of osmoregulation performance with transplantation outcomes and subsequent kidney function. RESULTS:Unlike controls, most kidney transplant recipients failed to maintain plasma sodium during water loading (plasma sodium slope of -0.6±0.4 mmol/L per hour in transplant recipients versus -0.12±0.3 mmol/L per hour in controls; P<0.001). Steeper plasma sodium reduction during the test independently associated with the composite outcome of all-cause mortality and allograft loss (hazard ratio [HR], 1.73 per 1 mmol/L per hour decrease in plasma sodium; 95% confidence interval [95% CI], 1.23 to 2.45; P=0.002) and allograft loss alone (HR, 2.04 per 1 mmol/L per hour decrease in plasma sodium; 95% CI, 1.19 to 3.51; P=0.01). The association remained significant in a prespecified sensitivity analysis excluding patients with hyperglycemia. In addition, a steeper plasma sodium slope 3 months after transplantation independently correlated with lower mGFR at 12 months (?=1.93; 95% CI, 0.46 to 3.41; P=0.01). CONCLUSIONS:Reduced osmoregulation performance occurs frequently in kidney transplant recipients and is an independent predictor of renal outcome.

SUBMITTER: Mazloum M

PROVIDER: S-EPMC6622417 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Osmoregulation Performance and Kidney Transplant Outcome.

Mazloum Manal M Jouffroy Jordan J Brazier François F Legendre Christophe C Neuraz Antoine A Garcelon Nicolas N Prié Dominique D Anglicheau Dany D Bienaimé Frank F

Journal of the American Society of Nephrology : JASN 20190619 7

<h4>Background</h4>Kidney transplant recipients have an impaired ability to dilute urine but seldom develop baseline hyponatremia before ESRD. Although hyponatremia is a risk factor for adverse events in CKD and in kidney transplant recipients, it remains unclear whether subtler alterations in osmoregulation performance are associated with outcome.<h4>Methods</h4>We studied a single-center prospective cohort of 1258 kidney transplant recipients who underwent a water-loading test 3 months after t ...[more]

PMID: 31217325

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Project description:BackgroundKidney transplant recipients have high cardiovascular risk, and vascular inflammation may play an important role. We explored whether the inflammatory state in the vessel wall was related to carotid intima-media thickness (c-IMT) and patient survival following kidney transplantation.MethodsIn this prospective observational cohort study we measured c-IMT and expression of proinflammatory cytokines and adhesion molecules in the inferior epigastric artery in 115 kidney transplant candidates. Another c-IMT measurement was done 1-year post-transplantation in 107. By stepwise multiple regression analysis we explored factors associated with baseline c-IMT and their changes over time. Multivariate Cox regression analysis was constructed to identify risk factors for mortality.ResultsA worse cardiovascular profile (older age, smoker, diabetic, carotid plaque, systolic blood pressure and vascular calcification) and higher VCAM-1 levels were found in patients in the highest baseline c-IMT tertile, who also had a worse survival. Factors independently related to baseline c-IMT were age (?=0.369, P<0.0001), fasting glucose (?=0.168, P=0.045), smoking (?=0.228, P=0.003) and VCAM-1 levels (?=0.244, P=0.002). Independent factors associated with c-IMT measurement 1-year post-transplantation were baseline c-IMT (?=-0.677, P<0.0001), post-transplant diabetes (?=0.225, P=0.003) and triglycerides (?=0.302, P=0.023). Vascular VCAM-1 levels were associated with increased risk of mortality in bivariate and multivariate Cox regression. Notably, nearly 50% of patients showed an increase or maintenance of high c-IMT 1 year post-transplantation and these patients experienced a higher mortality (13 versus 3.5%; P=0.021).ConclusionA worse cardiovascular profile and a higher vascular VCAM-1 protein levels at time of KT are related to subclinical atheromatosis. This could lead to a higher post-transplant mortality. Pre-transplant c IMT, post-transplant diabetes and triglycerides at 1-year post-transplantation may condition a high c-IMT measurement post-transplantation, which may decrease patient survival.

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Osmoregulation Performance and Kidney Transplant Outcome.

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Osmoregulation Performance and Kidney Transplant Outcome.

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