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Indicator Details — Solid Organ Transplant Population: Progression of CKD in Liver Transplant Recipients Between 1-Year and 3-Year Follow-up Visits, by Risk Factor
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Stratification and Year Choices:

  • SRTR

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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.

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.

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.

1Ojo AO. Renal disease in recipients of nonrenal solid organ transplantation. Semin Nephrol.2007;27(4):498-507. 
Description of MeasureProgression of CKD (by eGFR) and Renal Dysfunction
Data SourceScientific Registry of Transplant Recipients
Type of Data SourceRegistry
Data SetSRTR
Health Care System DataNo
Regional or National?National
Demographic GroupSolid Organ Transplant Recipients
NumeratorPatients in denominator with eGFR<60 (Liver, Kidney) or ‘renal dysfunction’ (Thoracic) at time of follow-up.
DenominatorPatients 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 CKDStage 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 rateEstimated 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 IndicatorSerum Creatinine measurements/Renal Dysfunction indicator
Primary Indicator Method of MeasurementTransplant follow-up
Secondary (1) VariableType of organ transplant
Secondary (1) Variable Method of MeasurementRegistry
Secondary (2) VariableAge
Secondary (2) Variable Method of MeasurementRegistry
Secondary (3) VariableRace/ethnicity
Secondary (3) Variable Method of MeasurementRegistry
Secondary (4) VariableGender
Secondary (4) Variable Method of MeasurementRegistry
Secondary (5) VariableDiabetes
Secondary (5) Variable Method of MeasurementRegistry
Secondary (6) VariableHypertension
Secondary (6) Variable Method of MeasurementRegistry
Secondary (7) VariableCalcineurin Treatment
Secondary (7) Variable Method of MeasurementRegistry
Secondary (8) VariableExpanded Criteria Donor Status
Secondary (8) Variable Method of MeasurementRegistry
Frequency of Measurement (Primary)Multiple measurements per patient
Period Currently Available1999–2015
Pending DataNone.
Additional Data Items of InterestTrends over time, other stratification variables of interest.
Limitations of IndicatorReporting 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 ConsiderationsMissing data on serum creatinine measurements may be informative.
References and Sources:

Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd