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Clinical Research
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Calcification Propensity and Survival among Renal Transplant Recipients

Charlotte A. Keyzer, Martin H. de Borst, Else van den Berg, Willi Jahnen-Dechent, Spyridon Arampatzis, Stefan Farese, Ivo P. Bergmann, Jürgen Floege, Gerjan Navis, Stephan J.L. Bakker, Harry van Goor, Ute Eisenberger and Andreas Pasch
JASN January 2016, 27 (1) 239-248; DOI: https://doi.org/10.1681/ASN.2014070670
Charlotte A. Keyzer
*Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
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Martin H. de Borst
*Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
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Else van den Berg
*Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
†Top Institute Food and Nutrition, Wageningen, The Netherlands;
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Willi Jahnen-Dechent
‡Helmholtz Institute for Biomedical Engineering, Biointerface Laboratory, Rheinisch-Westfälische Technische Hochschule, Aachen, Germany;
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Spyridon Arampatzis
§Department of Nephrology, Hypertension and Clinical Pharmacology, University Hospital Bern (Inselspital), Bern, Switzerland;
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Stefan Farese
‖Department of Nephrology, Bürgerspital Solothurn, Solothurn, Switzerland;
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Ivo P. Bergmann
¶Department of Internal Medicine, Emmental Hospital, Burgdorf, Switzerland;
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Jürgen Floege
**Department of Nephrology, Rheinisch-Westfälische Technische Hochschule University of Aachen, Aachen, Germany;
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Gerjan Navis
*Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
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Stephan J.L. Bakker
*Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
†Top Institute Food and Nutrition, Wageningen, The Netherlands;
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Harry van Goor
††Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
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Ute Eisenberger
‡‡Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany; and
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Andreas Pasch
§§Department of Clinical Chemistry, University Hospital Bern (Inselspital), Bern, Switzerland
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Abstract

Calciprotein particle maturation time (T50) in serum is a novel measure of individual blood calcification propensity. To determine the clinical relevance of T50 in renal transplantation, baseline serum T50 was measured in a longitudinal cohort of 699 stable renal transplant recipients and the associations of T50 with mortality and graft failure were analyzed over a median follow-up of 3.1 years. Predictive value of T50 was assessed for patient survival with reference to traditional (Framingham) risk factors and the calcium-phosphate product. Serum magnesium, bicarbonate, albumin, and phosphate levels were the main determinants of T50, which was independent of renal function and dialysis vintage before transplant. During follow-up, 81 (12%) patients died, of which 38 (47%) died from cardiovascular causes. Furthermore, 45 (6%) patients developed graft failure. In fully adjusted models, lower T50 values were independently associated with increased all-cause mortality (hazard ratio, 1.43; 95% confidence interval, 1.11 to 1.85; P=0.006 per SD decrease) and increased cardiovascular mortality (hazard ratio, 1.55; 95% confidence interval, 1.04 to 2.29; P=0.03 per SD decrease). In addition to age, sex, and eGFR, T50 improved prognostication for all-cause mortality, whereas traditional risk factors or calcium-phosphate product did not. Lower T50 was also associated with increased graft failure risk. The associations of T50 with mortality and graft failure were confirmed in an independent replication cohort. In conclusion, reduced serum T50 was associated with increased risk of all-cause mortality, cardiovascular mortality, and graft failure and, of all tested parameters, displayed the strongest association with all-cause mortality in these transplant recipients.

  • renal transplantation
  • mortality risk
  • graft failure
  • calcification propensity
  • serum T50
  • calciprotein particles
  • Copyright © 2016 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 27 (1)
Journal of the American Society of Nephrology
Vol. 27, Issue 1
January 2016
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Calcification Propensity and Survival among Renal Transplant Recipients
Charlotte A. Keyzer, Martin H. de Borst, Else van den Berg, Willi Jahnen-Dechent, Spyridon Arampatzis, Stefan Farese, Ivo P. Bergmann, Jürgen Floege, Gerjan Navis, Stephan J.L. Bakker, Harry van Goor, Ute Eisenberger, Andreas Pasch
JASN Jan 2016, 27 (1) 239-248; DOI: 10.1681/ASN.2014070670

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Calcification Propensity and Survival among Renal Transplant Recipients
Charlotte A. Keyzer, Martin H. de Borst, Else van den Berg, Willi Jahnen-Dechent, Spyridon Arampatzis, Stefan Farese, Ivo P. Bergmann, Jürgen Floege, Gerjan Navis, Stephan J.L. Bakker, Harry van Goor, Ute Eisenberger, Andreas Pasch
JASN Jan 2016, 27 (1) 239-248; DOI: 10.1681/ASN.2014070670
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Keywords

  • renal transplantation
  • mortality risk
  • graft failure
  • calcification propensity
  • serum T50
  • calciprotein particles

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