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Risk factors for reaching renal endpoints in the Assessment of Lescol in Renal Transplantation (ALERT) trial
Fellström, B., University Hospital, Uppsala, Sweden, Department of Medical Science, Renal Unit, University Hospital, Uppsala, Sweden.
Rikshospitalet, Oslo, Norway.
University of Glasgow, Glasgow, United Kingdom.
Sahlgrenska University Hospital, Göteborg, Sweden.
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2005 (English)In: Transplantation, ISSN 0041-1337, Vol. 79, no 2, 205-212 p.Article in journal (Refereed) Published
Abstract [en]

Background. The aim of the study was to identity risk factors for long-term renal transplant function and development of chronic allograft nephropathy (CAN) in renal transplant recipients included in the Assessment of Lescol in Renal Transplantation (ALERT) trial. Methods. The ALERT trial was a randomized, double-blind, placebo-controlled study of the effect of fluvastatin, 40 and 80 mg/day, in renal transplant recipients who were randomized to receive fluvastatin (Lescol) (n=1,050) or placebo (n=1,052) over 5 to 6 years of follow-up. Renal endpoints including graft loss or doubling of serum creatinine or death were analyzed by univariate and multivariate regression analysis in the placebo group. Results. There were 137 graft losses (13.5%) in the placebo group, mainly caused by CAN (82%). Univariate risk factors for graft loss or doubling of serum creatinine were as follows: serum creatinine, proteinuria, hypertension, pulse pressure, time since transplantation, donor age, human leukocyte antigen-DR mismatches, treatment for rejection, low high-density lipoprotein cholesterol, and smoking. Multivariate analysis revealed independent risk factors for graft loss as follows: serum creatinine (relative risk [RR], 3.12 per 100-µM increase), proteinuria (RR, 1.64 per 1-g/24 hr increase), and pulse pressure (RR, 1.12 per 10 mm Hg), whereas age was a protective factor. With patient death in the composite endpoint, diabetes mellitus, smoking, age, and number of transplantations were also risk factors. Conclusions. Independent risk factors for graft loss or doubling of serum creatinine or patient death are mainly related to renal transplant function, proteinuria, and blood pressure, which emphasizes the importance of renoprotective treatment regimens in this population.

Place, publisher, year, edition, pages
2005. Vol. 79, no 2, 205-212 p.
Keyword [en]
Chronic rejection, Graft loss, Renal transplantation, Risk factors
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-45525DOI: 10.1097/01.TP.0000147338.34323.12OAI: diva2:266421
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2011-01-12

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Olsson, Anders
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Faculty of Health SciencesInternal Medicine Department of Endocrinology and Gastroenterology UHL
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