Non-Immunological Factors in Chonic Kidney Disease in Kidney Transplant

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Introduction and ObjectivesKidney transplant reseatch (TR) has focused on immunological factors that determine the loss of the graft. "Non-immunological" factors are well recognized as risk factors for end stage kidney disease in native kidneys. The objective of this study was to evaluate the control of "non-immunological" factors and relation to annual glmerular filtration decine in kidney transplant recipients.MethodsA descriptive, retrospective study. We included 128 patients who received kidney transplant between 2000 and 2015, with at least 1-year post-transplant follow-up and information in 2015 and 2016. Clinical records were reviewed. Glomerular filtration rate (GFR)was estimated by CKD-EPI. 2 groups were defined according to the annual change in eGFR: stabilized (Δ GFR 2016-2015 < -1ml/min/1.73m2)and non stabilized Δ GFR 2016-2015 ≥-1ml/min/1.73m2. The percentage of patients with chronic kidney disease in kidney transplant who meet the KDIGO objectives was also analyzed. It was compared with the population with CKD in native kidneys included in the National Follow-up Program of the CKD ( n=5330)ResultsThe mean GFR was 62.5 ml / min / 1.73m2. Glomerulonephritis was the most common cause of kidney failure (36%). 75% of patients were in CKD stages 2 and 3. 40 to 60% met KDIGO targets, similar to native kidneys. In non-stabilized group: age at transplant was lower (40 ± 12.3 years). episodes of acute kidney injury (25.8%), post-transplant BMI (27.4 ± 5.6 kg / m2) and uric acid levels (6.4 ± 1.7 mg / dL) wer significantly highly. Biopsy proven acute rejection was higher in non- staabilized group, without statical significance. There were no differences between stabilized and unstabilized blood pressure, dyslipidemia, proteinuria or venous bicarnonatemiaConclusionOnly half of the patients met KDIGO targets was low.However, when compared of KDIGO target in native kidneys, the percentage was similar. The only non-immunological factors that were significantly different in the non-stabilized population were BMI and uricemia. It is noteworthy that in the non-stabilized group, patients were younger and non-adherence to immunosuppressive treatment can not be ruled out.

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