Article Figures & Data
Figures
- Figure 1.
Kaplan–Meier curve for mortality and graft failure. (A) All-cause mortality, (B) cardiovascular mortality, and (C) death-censored graft failure among renal transplant recipients according to tertiles of baseline T50.
- Figure 2.
Forest plot of sub-analyses of serum T50 demonstrating that hazard ratios for all-cause mortality were consistent in different subgroups.
- Figure 3.
Comparative analysis of serum T50 with serum corrected calcium (Ca), phosphate (Pi), magnesium (Mg), parathyroid hormone (PTH) and calcium-phosphate (Ca×Pi) product, displayed per tertile as independent risk factors for all-cause mortality. Bars represent hazard ratio with 95% CI. (A) Crude analyses. (B) Adjustment for age, gender, eGFR, albuminuria, Framingham risk factors (systolic BP, body mass index, smoking, diabetes mellitus and LDL cholesterol), high-sensitivity C-reactive protein (hsCRP), calcineurin inhibitor use, dialysis vintage and type of donor (living versus deceased). Tertile with the lowest risk on mortality served as reference group (R).
Tables
- Table 1.
Baseline patient characteristics of the study population presented as tertiles of serum T50 in stable renal transplants
Characteristics Renal transplant recipients Tertiles of T50 Overall n=699 Tertile 1 n=231 Tertile 2 n=233 Tertile 3 n=235 P Value T50 (minutes) 286±62 <262 262–311 >311 <0.001a Demographics Age, years 53.0±12.8 53.6±12.7 53.6±13.0 51.9±12.6 0.26 Male gender, n (%) 398 (57) 135 (58) 128 (55) 135 (57) 0.73 Current smoker, n (%) 84 (13) 31 (15) 25 (11) 28 (13) 0.62 Current diabetes, n (%) 170 (24) 62 (27) 63 (27) 45 (19) 0.08 BMI, kg/m2 26.7±4.8 26.9±5.1 26.8±4.6 26.2±4.6 0.27 Systolic BP, mmHg 135.9±17.4 136.6±17.9 136.0±16.6 135.1±17.6 0.66 Diastolic BP, mmHg 82.5±10.9 82.7±10.9 82.5±10.2 82.4±11.7 0.95 Heart rate, bpm 68.6±11.9 69.2±13.0 68.8±11.6 67.9±11.1 0.49 Renal Transplantation Transplant vintage, years 5.4 [1.9–12.1] 6.1 [1.7–12.8] 5.3 [2.0–12.3] 5.2 [1.8–10.1] 0.54 Living donor, n (%) 236 (34) 61 (27) 77 (34) 98 (42) 0.002a Pre-emptive transplant, n (%) 105 (15) 28 (12) 35 (15) 42 (18) 0.22 Dialysis vintage, months 27 [9–52] 29 [10–55] 25 [10–48] 25 [8–51] 0.22 HLA mismatches, n 2 [1–3] 2 [1–3] 2 [1–3] 2 [1–3] 0.50 Age donor, years 42.8±15.6 41.2±16.2 43.2±15.3 43.8±15.2 0.19 Acute rejection, n (%) 186 (27) 69 (30) 67 (29) 50 (21) 0.07 Laboratory measurements Hemoglobin, mmol/L 8.2±1.1 8.0±1.1 8.3±1.1 8.4±1.0 <0.001a HbA1c, % 6.00±0.83 6.02±0.88 6.08±0.89 5.85±0.69 0.01a eGFR, CKD-EPI (mL/min per 1.73 m2) 52.4±20.2 46.6±20.3 53.3±19.3 56.7±19.5 <0.001a Corrected calcium, mmol/L 2.41±0.15 2.37±0.14 2.40±0.14 2.45±0.15 <0.001a Phosphate, mmol/L 0.96±0.21 1.07±0.24 0.95±0.17 0.87±0.18 <0.001a Magnesium, mmol/L 0.95±0.12 0.93±0.13 0.95±0.11 0.98±0.11 <0.001a PTH, pmol/L 9.0 [5.9–14.7] 8.7 [5.2–15.9] 9.1 [6.2–14.4] 9.1 [6.3–14.1] 0.48 Venous pH 7.37±0.04 7.36±0.05 7.37±0.04 7.37±0.04 <0.001a Venous HCO3–, mmol/L 24.6±3.1 23.6±3.6 24.5±2.6 25.8±2.6 <0.001a hsCRP, mg/L 1.6 [0.7–4.6] 1.9 [0.8–6.2] 1.5 [0.8–4.4] 1.4 [0.6–3.5] 0.01a Albumin, g/L 43.0±3.0 42.1±3.1 42.8±2.7 44.0±2.8 <0.001a Alkaline phosphatase, U/L 67 [54–83] 67 [53–84] 69 [55–83] 66 [51–83] 0.21 Total cholesterol, mmol/L 5.0 [4.4–5.8] 4.9 [4.2–5.9] 4.9 [4.3–5.6] 5.2 [4.5–5.8] 0.03a HDL cholesterol, mmol/L 1.3 [1.1–1.6] 1.3 [1.1–1.6] 1.3 [1.0–1.6] 1.3 [1.1–1.7] 0.09 LDL cholesterol mmol/L 2.9 [2.3–3.5] 2.8 [2.2–3.6] 2.9 [2.3–3.4] 2.9 [2.5–3.6] 0.08 Triglycerides, mmol/L 1.68 [1.25–2.30] 1.71 [1.24–2.47] 1.67 [1.25–2.23] 1.66 [1.24–2.24] 0.65 Albuminuria, mg/24 h 40 [11–182] 82 [16–300] 36 [9–133] 25 [9–112] <0.001a Medication Antihypertensives, n (%) 616 (88) 211 (91) 202 (87) 203 (86) 0.18 Statins, n (%) 371 (53) 135 (58) 125 (54) 111 (47) 0.05a Calcium supplements, n (%) 150 (21) 72 (31) 47 (20) 31 (13) <0.001a Vitamin D supplements, n (%) 171 (24) 73 (32) 45 (19) 53 (23) 0.006a Vitamin K antagonists, n (%) 78 (11) 37 (16) 20 (9) 21 (9) 0.02a Prednisone, mg/d 10 [7.5–10] 10 [7.5–10] 10 [7.5–10] 10 [7.5–10] 0.17 Calcineurin inhibitors, n (%) 400 (57) 153 (66) 133 (57) 114 (49) 0.001a Proliferation inhibitors, n (%) 584 (84) 182 (79) 202 (87) 200 (85) 0.05 Sirolimus, n (%) 13 (2) 3 (1) 4 (2) 6 (3) 0.69 ↵a Differences were tested by ANOVA or Kruskal–Wallis test for continuous variables and with chi-squared test for categorical variables.
Data are represented as mean±SD or median [IQR]. BMI, body mass index; HbA1c, glycated hemoglobin; HCO3–, bicarbonate; hsCRP, high-sensitivity C-reactive protein.
- Table 2.
Associations of calcification propensity, serum T50, with all-cause mortality and cardiovascular mortality in stable renal transplant recipients
High Intermediate Low Serum T50 continuous HR (95% CI) HR (95% CI) P (trend) Value HR (95% CI) per SD P Value All-cause mortality (nevents/ntotal=81/699) Model 1a 1.0 (Ref) 1.91 (0.99–3.70) 4.09 (2.23 to 7.49) <0.001 1.69 (1.37 to 2.09) <0.001 Model 2b 1.0 (Ref) 1.77 (0.91–3.42) 3.77 (2.06 to 6.91) <0.001 1.69 (1.36 to 2.09) <0.001 Model 3c 1.0 (Ref) 1.77 (0.90–3.49) 3.54 (1.88 to 6.65) <0.001 1.57 (1.26 to 1.97) <0.001 Model 4d 1.0 (Ref) 2.03 (0.98–4.19) 3.50 (1.74 to 7.01) <0.001 1.56 (1.23 to 2.00) <0.001 Model 5e 1.0 (Ref) 1.58 (0.76–3.32) 2.86 (1.41 to 5.80) 0.002 1.43 (1.11 to 1.85) 0.006 Cardiovascular mortality (nevents/ntotal=38/699) Model 1a 1.0 (Ref) 3.25 (0.88–12.02) 7.18 (2.09 to 24.72) 0.001 1.70 (1.19 to 2.43) 0.003 Model 2b 1.0 (Ref) 3.12 (0.84–11.55) 6.82 (1.98 to 23.50) 0.001 1.71 (1.18 to 2.46) 0.004 Model 3c 1.0 (Ref) 3.02 (0.82–11.19) 6.12 (1.75 to 21.44) 0.002 1.61 (1.10 to 2.36) 0.01 Model 4d 1.0 (Ref) 2.75 (0.74–10.30) 6.07 (1.72 to 21.44) 0.002 1.59 (1.08 to 2.35) 0.02 Model 5e 1.0 (Ref) 2.63 (0.70–9.92) 5.58 (1.58 to 19.72) 0.003 1.55 (1.04 to 2.29) 0.03 Data are presented as hazard ratio (HR) plus 95% CI according to tertiles of serum T50 and per SD serum T50 decrease. Mean±SD, T50: 286±62 minutes.
↵a Model 1: crude.
↵b Model 2: adjusted for age and gender.
↵c Model 3: adjusted for model 2 plus eGFR (CKD-EPI) and albuminuria.
↵d Model 4: adjusted for model 3 plus current smoking, body mass index, diabetes mellitus, systolic BP and LDL cholesterol.
↵e Model 5: adjusted for model 4 plus high-sensitivity C-reactive protein, calcineurin inhibitor use, dialysis vintage and type of kidney transplant (living versus deceased donor).
Without serum T50a With serum T50 <5% 5%–10% >10% Total (n) Patients with all-cause mortalityb,c <5% 4 4d 8 5%–10% 9 4d 13 >10% 3e 57 60 Total 4 16 61 81 Patients without all-cause mortalityb,c <5% 176 17e 193 5%–10% 43d 90 22e 155 >10% 3d 40d 225 268 Total 222 147 247 616 ↵a Multivariable model including recipient age and gender and eGFR (CKD-EPI).
b Net reclassification improvement was 14%, P=0.002.
c 697 RTR were included in this analysis.
↵d Numbers of patients who were correctly reclassified by the model with serum T50.
↵e Numbers of patients who were incorrectly reclassified by the model with serum T50.
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