The proportion of all kidney transplant recipients with CKD (stages 3-5) at 1-year post-transplant was about 50%; the proportion with ESRD (dialysis or kidney retransplant) was less than 2%.
Chart Explanation: The x-axis shows the status of adult (age > 21 years) kidney transplant recipients at 1-year post-transplant. Categories included are CKD Stages 1-5, dialysis, retransplant, death and not measured eGFR.
The y-axis shows the percentage of adult kidney transplant recipients at 1-year post-transplant that fall within each of the categories listed on the x-axis.
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 aged 20 years or older at the time of their first organ transplant. These data are nationally-representative of the first-time, solid-organ transplant population with less 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.
Information on kidney transplant recipients included serum creatinine measurements for each follow-up visit as well as whether the patient has been treated for end-stage renal disease (ESRD) through dialysis or a kidney retransplant since the last follow-up. CKD stages 3-5 is defined by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) study equation eGFR <60 ml/min/1.73 m². Additional data collected for kidney transplant recipients includes donor type (deceased vs. living donor), and whether the donor was considered an expanded criteria donor (e.g., a donor that may have been advanced in age, had diabetes, or had prior infection with hepatitis B or C).
1Ojo AO. Renal disease in recipients of nonrenal solid organ transplantation. Semin Nephrol.2007;27(4):498-507.
|Description of Measure||Prevalence 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 2006 and 2016 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 MDRD formula for calibrated creatinine: eGFR=186 × [(calibrated serum creatinine in mg/dl)-1.154] × age-0.203 × (0.742 if female) × (1.210 if African-American)|
|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||2007-2017|
|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.|