Higher stages of CKD at 1-year post-transplant were associated with more severe progression by the third year.
Chart Explanation: The results presented show the progression of CKD in solid organ recipients from their first year of follow-up to their third year, including progression to ESRD or death.
Individuals who received a solid organ transplant in the United States were followed up annually for assessment of their health status. These data were recorded in the Scientific Registry of Transplant Recipients (SRTR). All analyses presented are limited to adults, 20 years of age and older, at the time of their first organ transplant. These data are nationally-representative of the first-time, solid-organ transplant population with fewer than 5% lacking information on kidney function.
Patients were classified into those that showed worsening eGFR over three years (i.e., moving to a more severe stage of CKD), stable (i.e., remaining in the same CKD stage) and those that showed apparent “improvement” (i.e. moved to a less severe CKD stage). These categories were then examined by age categories, gender, race/ethnicity, diabetes, and hypertension for a preliminary examination of potential predictors of change in CKD stage over the three years.
Diabetes status (type 1 or 2) and hypertension status are as listed at the time of transplant. For all transplant recipients, use of calcineurin inhibitors (CNI) to prevent transplant rejection is presented as many of these medications have been shown to be nephrotoxic1. The recording of data in the SRTR pertaining to CKD/kidney function varied by organ type and is discussed below.
1Ojo AO. Renal disease in recipients of nonrenal solid organ transplantation. Semin Nephrol.2007;27(4):498-507.
|Description of Measure||Progression of CKD (by eGFR) and Renal Dysfunction|
|Data Source||Scientific Registry of Transplant Recipients|
|Type of Data Source||Registry|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||Solid Organ Transplant Recipients|
|Numerator||Patients in denominator with eGFR<60 (Liver, Kidney) or ‘renal dysfunction’ (Thoracic) at time of follow-up.|
|Denominator||Patients with a valid follow-up code who had a first solid organ transplant between 1999 and 2015 and were at least 20 years old at time of transplant.|
|Definition of diagnosed CKD||Stage 3, eGFR 30-59 ml/min per 1.73 m² Stage 4, 15-29 ml/min per 1.73 m²
Stage 5, <15 ml/min per 1.73 m²|
|Glomerular filtration rate||Estimated using CKD-EPI formula for calibrated creatinine:|
GFR = 141 × min (Scr /κ, 1)α × max(Scr /κ, 1)-1.209 × 0.993Age × 1.018 [if female] × 1.159 [if black]
|Primary Data Source Indicator||Serum Creatinine measurements/Renal Dysfunction indicator|
|Primary Indicator Method of Measurement||Transplant follow-up|
|Secondary (1) Variable||Type of organ transplant|
|Secondary (1) Variable Method of Measurement||Registry|
|Secondary (2) Variable||Age|
|Secondary (2) Variable Method of Measurement||Registry|
|Secondary (3) Variable||Race/ethnicity|
|Secondary (3) Variable Method of Measurement||Registry|
|Secondary (4) Variable||Gender|
|Secondary (4) Variable Method of Measurement||Registry|
|Secondary (5) Variable||Diabetes|
|Secondary (5) Variable Method of Measurement||Registry|
|Secondary (6) Variable||Hypertension|
|Secondary (6) Variable Method of Measurement||Registry|
|Secondary (7) Variable||Calcineurin Treatment|
|Secondary (7) Variable Method of Measurement||Registry|
|Secondary (8) Variable||Expanded Criteria Donor Status|
|Secondary (8) Variable Method of Measurement||Registry|
|Frequency of Measurement (Primary)||Multiple measurements per patient|
|Period Currently Available||1999–2015|
|Additional Data Items of Interest||Trends over time, other stratification variables of interest.|
|Limitations of Indicator||Reporting of data across organ types is not consistent. Reporting of kidney function for thoracic recipients may be subjective. Serum creatinine measurements are only taken once per follow-up, probably resulting in a large standard error.|
|Analytical Considerations||Missing data on serum creatinine measurements may be informative.|