A thirty percent chronic decline in inverse serum creatinine is an excellent predictor of late renal allograft failure

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
B L KasiskeB Danielson

Abstract

We previously reported that the percentage of change in inverse serum creatinine (Delta1/Cr) was the best of several time-dependent serum creatinine-derived predictors of renal allograft failure in patients not administered cyclosporine (CsA). To further validate the utility of Delta1/Cr, we collected creatinine levels (mean, 90.7 +/- 45.2 creatinine measurements) in 100 patients treated for 6.7 +/- 5.9 years with CsA. We also validated Delta1/Cr using a limited creatinine-sampling strategy, then performed multivariate Cox proportional hazards analysis of 1,663 transplantations. A time-dependent covariate determined by the date of first chronic decline (excluding creatinine levels from periods of acute rejection) in Delta1/Cr to less than -30% of baseline similarly was predictive of graft failure in 101 patients treated without CsA (relative risk, 5.04; 95% confidence interval, 2.18 to 11.6; P = 0.0002) and 100 patients treated with CsA (relative risk, 5.02; 95% confidence interval, 2.50 to 10.1; P < 0.0001). A limited creatinine-sampling strategy (measured at 1 week, 1, 3, 6, 12, 18, 24, and 36 months, and each year thereafter) reduced the ability of Delta1/Cr less than -30% to predict graft failure. In 1,663 patients, Delta1/...Continue Reading

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