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Urinary Albumin Excretion and the Risk of Graft Loss and Death in Proteinuric and Non-proteinuric Renal Transplant Recipients

  1. J.-M. Halimi1,2,4,*,
  2. M. Buchler1,
  3. A. Al-Najjar1,3,
  4. I. Laouad1,
  5. Valérie Chatelet1,
  6. J.-F. Marlière1,
  7. H. Nivet1,3,
  8. Y. Lebranchu1,3

Article first published online: 11 JAN 2007

DOI: 10.1111/j.1600-6143.2007.01665.x

Issue

American Journal of Transplantation

American Journal of Transplantation

Volume 7, Issue 3, pages 618–625, March 2007

Additional Information

How to Cite

Halimi, J.-M., Buchler, M., Al-Najjar, A., Laouad, I., Chatelet, V., Marlière, J.-F., Nivet, H. and Lebranchu, Y. (2007), Urinary Albumin Excretion and the Risk of Graft Loss and Death in Proteinuric and Non-proteinuric Renal Transplant Recipients. American Journal of Transplantation, 7: 618–625. doi: 10.1111/j.1600-6143.2007.01665.x

Author Information

  1. 1

    François Rabelais University, Department of Nephrology and Clinical Immunology, CHU Tours, Tours, France

  2. 2

    François Rabelais University, Centre d'Investigation Clinique 202 INSERM, CHU Tours, Tours, France

  3. 3

    François Rabelais University, JE 2448, Tours, France

  4. 4

    François Rabelais University, EA 3852, Tours, France

* * Corresponding author: Jean-Michel Halimi, halimi@med.univ-tours.fr

Publication History

  1. Issue published online: 11 JAN 2007
  2. Article first published online: 11 JAN 2007
  3. Revised manuscript October 23 2006

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Keywords:

  • Proteinuria;
  • renal transplantation;
  • survival;
  • urinary albumin excretion

Background: Microalbuminuria and macroalbuminuria constitute risk factors for ESRD and death in non-transplanted populations. Whether microalbuminuria (especially in non-proteinuric patients) and macroalbuminuria constitute risk factors for graft loss and death is presently unknown in renal transplantation.

Methods: We retrospectively assessed the association between urinary albumin excretion (UAE) and ESRD and death in renal transplantation.

Results: UAE was measured in 616 (397 proteinuric; 219 non-proteinuric patients) renal transplant recipients. They were grafted for 62 months (range: 6–192). During the 40 months (3.7–99) thereafter, 31 patients underwent dialysis and 32 died.

Microalbuminuria (vs. normoalbuminuria) and macroalbuminuria (vs. microalbuminuria) were powerful risk factors for graft loss [OR: 14.25 (2.88–52.3) and 16.41 (7.46–36.0), respectively, both p < 0.0001], even after adjustments on renal function and diabetes.

Among the 219 non-proteinuric patients, microalbuminuria (vs. normoalbuminuria) was a significant risk factor for graft loss [OR: 23.09 (1.93–276.4), p = 0.0132].

Both microalbuminuria (vs. normoalbuminuria) [OR: 5.55 (2.43–12.66), p < 0.0001] and macroalbuminuria (vs. microalbuminuria) [OR: 4.12 (1.65–10.29), p = 0.0024] were predictive of death.

Conclusions: Microalbuminuria and macroalbuminuria are powerful independent predictors of ESRD and death. Microalbuminuria is a risk factor for graft loss even in non-proteinuric patients. UAE provides additional information on renal and patient prognosis as compared to proteinuria and renal function.

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