Time-Varying Proteinuria and the Risk of Cardiovascular Disease and Graft Failure in Kidney Transplant Recipients.
Bibliographic record
Abstract
Purpose: The primary objective of this study was to determine the association between post-transplant proteinuria and the risk of cardiovascular events in a cohort of kidney transplant recipients using a time-dependent analysis. Methods: All eligible patients who received a kidney transplant at our center from 1 Jan 2000 to 31 Dec 2011 were followed from one-month post-transplant to the date of first cardiac event, graft failure, death, lost to follow-up, or 31 Dec 2012. Urine protein concentration, measured by dipstick on a random spot urine sample (trace = 0.15 to 0.30 g/d, 1+ = 0.3 to 1.0 g/d, 2+= 1.0 to 3.0 g/d or 3+ = ≥ 3.0 g/d), was assessed quarterly during the first year post-transplant, biannually during years 2 and 3, and annually thereafter. The primary endpoint was a major adverse cardiac event (MACE) defined as (i) acute myocardial infarction, (ii) cerebrovascular accident, (iii) revascularization, or (iv) all-cause mortality.To account for changing levels of urine protein over follow-up, time-dependent, multivariable Cox proportional hazards models were used to analyze the data. Results: The final study cohort included 1,107 patients followed for 5,704.8 person-years with 142 MACE. Any proteinuria detected by dipstick (i.e., ≥ trace) resulted in a two-fold increase in the risk of MACE vs. no proteinuria (hazard ratio [HR] = 2.11 [95% CI: 1.51, 2.95]). Trace urine protein was associated with the greatest risk of MACE (HR = 2.68 [95% CI: 1.62, 4.45]), while 1+, 2+, and 3+ showed relative hazards of 1.37 (95% CI: 0.82, 2.30), 1.49 (95% CI: 0.82, 2.71), and 1.29 (95% CI: 0.57, 2.92), respectively. Of note, the risk of graft failure significantly and monotonically increased with increasing levels of urine protein concentration (HR = 2.44 [95% CI: 0.89, 6.67], 2.69 [95% CI: 1.27, 5.68], 6.34 [95% CI: 3.30, 12.18], and 18.86 [95% CI: 10.11, 35.18] for trace, 1+, 2+ and 3+ compared to negative, respectively). Conclusion: Any level of proteinuria detected by dipstick is associated with a greater risk of MACE in kidney transplant recipients. The lack of dose-response may have resulted from decreased follow-up time in patients with severe proteinuria (due to an increased risk of graft failure) and a relatively low event rate. The role of interventions to reduce proteinuria on decreasing the risk of adverse cardiovascular and graft outcomes in kidney transplant recipients requires further study. DISCLOSURES:Kim, S.: Grant/Research Support, Astellas Pharma Canada, Novartis Pharma Canada, Genzyme Canada.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".