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Achieving Chronic Kidney Disease Treatment Targets in Renal Transplant Recipients: Results From a Cross-Sectional Study in Spain

2009; Wolters Kluwer; Volume: 87; Issue: 9 Linguagem: Inglês

10.1097/tp.0b013e3181a23837

1534-6080

Roberto Marcén, Domingo del Castillo, Lluís Capdevila, Gema Fernández‐Fresnedo, Emilio Rodrigo, Carmen Cantarell, Ana Fernández‐Rodríguez, María O. López‐Oliva, J Camps, Pedro Aljama, J. Ortuño, Manuel Arias,

Neurological Complications and Syndromes

Kidney transplant recipients are considered to have chronic kidney disease (CKD) irrespective of glomerular filtration rate (GFR) or presence or absence of markers of kidney damage. The aim of this work was to investigate the prevalence of CKD-stages and whether the guidelines for general population (Kidney Disease Outcomes Quality Initiative) are routinely followed in kidney transplant in Spain.Two thousand one hundred sixty renal transplant recipients followed up at the outpatient clinics in 4 University Hospitals were included. The estimated GFR (eGFR) was calculated according to the abbreviated modification of diet in renal disease equation, and the patients were classified following the Kidney Disease Outcomes Quality Initiative stages.Chronic kidney failure (eGFR <60 mL/min/1.73 m) was present in 1505 patients (69.7%), 54.4% were 3T-stage (eGFR 30-59); 13.0% were 4T-stage (eGFR 15-30), and 2.3% were 5T-stage. The prevalence of severe anemia increased from 4.1% in 1T-stage to 44% in 5T-stage (P=0.000) as did the percentage of patients on erythropoiesis-stimulating agents from 1.3% to 68% (P=0.000). The intact parathyroid hormone levels increased as graft function declined and 45% of 5T-stage patients had intact parathyroid hormone levels more than 300. Calcium and vitamin D supplements were administered to 50% and 40% of patients, respectively. Hypertension was quite common and increased with the progression of CKD. The mean total cholesterol was 192+/-39 mg/dL, and the levels did not increase with the decline in graft function. Approximately 60% had suboptimal cholesterol despite 50% being on statins treatment.CKD and their complications were prevalent in renal transplant recipients. The control of some of these complications is far below targets established for nontransplant CKD patients despite a progressive intensification of therapy as graft function declines.