Analysis of Uric Acid and other Factors affecting Renal Function in the Monitoring of Renal Transplant Recipients

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IntroductionThe two major factors associated with long-term renal allograft loss continue to be death with a functioning graft and chronic allograft nephropathy (CAN). Numerous risk factors for graft injury have been identified as possible contributors to CAN including: acute injury and chronic injury factors.The aim of this study is to identify the clinical factors that impact graft function in renal transplant recipients.MethodsThis was a retrospective cohort study using the medical records of 120 patients attending the outpatient transplant clinic for the period January 2012 to January 2014.The patients were followed up at three monthly intervals for a total of 24 months.Socio-demographic and clinical characteristics were recorded.Data analysis using SPSS version 24 (IBM) comprised of descriptive tests and linear regression analysis (expressed as OR (odd ratio) and confidence interval) for the study of the association of above characteristics with patients’ outcome.Linear regression analysis was performed using difference in serum creatinine (Creatinine at visit 9 minus creatinine at visit 1) and age, gender, BMI, race, proteinuria, ACEI, cholesterolaemia and hyperuricaemia, non-dihydropyridine calcium channel blockers (NCCB).Results and DiscussionLinear regression analysis of change in serum creatinine and uric acid performed showed a high uric acid at baseline was associated with significant decline in serum creatinine (p value 0.025).Linear regression analysis showed NDCCB had a protective effect on serum creatinine (p value 0.02).Multivariate linear regression analysis of worsening renal function in the presence of two variables NDCCB and CNI showed that NDCCB protective effect was dependent on patients being on CNI treatment and the protective effects of CNI was independent of NDCCB use(p value 0.002).Logistic regression analysis of change in serum creatinine in CNI vs Sirolimus showed CNI use was associated with less decline in serum creatinine vs sirolimus (p value 0.006), however most patients were started on a CNI first and converted to sirolimus.ConclusionOur study suggested that an elevated uric acid at baseline was associated with decline in serum creatinine in allograft recipients over a 2 year period. While NDCCB had a protective effect, this was limited to patients on calcineurin inhibitors.

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