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2023, Number 1

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Rev Nefrol Dial Traspl 2023; 43 (1)

The relationship between uric acid levels and graft function in renal transplant patients who discontinued steroid therapy

Colak H, Ersan S, Tanrisev M, Yilmaz B, Ural O, Unal Z, Sert I

Language: English
References: 25
Page: 17-23
PDF size: 115.80 Kb.


ABSTRACT

Introduction: High uric acid levels are commonly encountered in kidney transplant recipients, and can be associated with allograft dysfunction. Our study aims to examine the relationship between UA levels and graft function in patients discontinuing steroids. Methods: In this single-center-retrospective study, 56 patients discontinued steroid therapy from among 678 RT patients transplanted from living donors between 1999-2020 were included. Le mean age of the study group was 45.8±8.8 years. Causes of steroid discontinuation, creatinine levels concurrent with uric acid levels before and after steroid discontinuation (mean 3.9 ± 2.1 years), acute rejection numbers, demographics, durations of dialysis and transplantation, medications, laboratory data, human leukocyte antigen (HLA) mismatch numbers, blood-pressure (BP), body mass index, delayed acute rejection (DAR) numbers (3 months post-transplantation) were all recorded. Results: Creatinine and uric acid levels were seen to have increased after steroid discontinuation, there was a significant relationship between them (p‹0.001). Statistically significant correlation was found between increased creatinine levels after steroid discontinuation and graft survival with higher HLA mismatch; 39 (69.6%) patients with mismatch ≥2, and 17 patients with mismatch ‹2 (30.4%) (p=0.049) . No significant relationship was found between DAR numbers before and after steroid discontinuation, and creatinine levels after steroid discontinuation. Conclusion: Per model obtained as a result of multivariate linear analysis, hyperuricemia and HLA mismatch numbers (p= 0.048 and p= 0.044, respectively) are independent predictive factors for graft dysfunction in patients discontinuing steroids. Accordingly, negative eiects of modeling should be kept in mind for long-term graft survival in patients who plan to continue with steroid-sparing regimens.


REFERENCES

  1. Richard J Johnson, George L Bakris, Claudio Borghi,Michel B Chonchol, David Feldman, MiguelALanaspa, et al. Hyperuricemia, Acute and ChronicKidney Disease, National Kidney Foundation. Am JKidney Dis. 2018 Jun;71(6):851-865.

  2. Johnson RJ, Kang DH, Feig D, Kivlighn S, KanellisJ, Watanabe S, et al. Is there a pathogenetic role foruric acid in hypertension and cardiovascular and renaldisease? Hypertension 2003; 41:1183–1190.

  3. Armstrong KA, Johnson DW, Campbell SB, Isbel NM,Hawley CM. Does uric acid have a pathogenetic role ingraft dysfunction and hypertension in renal transplantrecipients? Transplantation 2005; 80:1565–1571.

  4. Mazzali M. Uric acid and transplantation. SeminNephrol. 2005; 25:505.

  5. Borghi C, Rosei EA, Bardin T, Dawson J, DominiczakA, Kielstein JT, et al. Serum uric acid and the risk ofcardiovascular and renal disease. J Hypertens. 2015Sep;33(9):1729-41.

  6. Viazzi F, Leoncini G, Pontremoli R. Cardiovascular and renal eects of hyperuricaemia and gout.Reumatismo.2012 Jan 19;63(4):253-62.

  7. Farah Bandukwala, Michael Huang, Jerey S Zaltzman, Michelle M Nash, G V Ramesh Prasad. Association of uric acid with inammation, progressive renal allograft dysfunction and posttransplant cardiovascular risk. AmJ Cardiol. 2009 Mar 15;103(6):867-71.

  8. Kanbay M, Akcay A, Huddam B, C A Usluogullari,Z Arat, F N Ozdemir, M Haberal. Inuence ofcyclosporine and tacrolimus on serum uric acid levelsin stable kidney transplant recipients. Transplant Proc.2005; 37:311920.

  9. Dujovne CA, Azarno DL. Clinical complicationsof corticosteroid therapy: A selected review. Steroidtherapy. Med Clin North Am. 1973 Sep;57(5):1331-42.

  10. Akgul A, Bilgic A, Ibis A, Ozdemir FN, Arat Z,Haberal M. Is uric acid a predictive factor for graftdysfunction in renal transplant recipients? Transplant Proc. 2007 May;39(4):1023-6.

  11. Jalalzadeh M, Mousavinasab N, Peyrovi S, GhadianiMH. e impact of acute rejection in kidneytransplantation on longterm allograft and patientoutcome. Nephrourol Mon. 2015 Jan 20;7(1): e24439.

  12. Burke G, 3rd., Ciancio G, Figueiro J, Olson L,Gomez C, Rosen A, et al. Can acute rejection beprevented in SPK transplantation? Transplant Proc.2002;34(5):1913–4.

  13. Hamida FB, Barbouch S, Bardi R, Helal I, KaaroudH, Fatma LB, et al. Acute rejection episodes afterkidney transplantation. Saudi J Kidney Dis Transpl.2009;20(3):370–4.

  14. Wang D, Xu TZ, Chen JH, Wu WZ, Yang SL, LinWH, et al. Factors inuencing second renal allograftsurvival: a single center experience in China. Transpl Immunol. 2009;20(3):150–4.

  15. Kuypers DR. Immunosuppressive drug therapy andsubclinical acute renal allograft rejection: impact andeect. Transplantation. 2008;85(7 Suppl):S25–30.

  16. Pascual M, eruvath T, Kawai T, Tolko-RubinN, Cosimi AB. Strategies to improve long-termoutcomes after renal transplantation. N Engl J Med.2002;346(8):580–90.

  17. Pallardo Mateu LM, Sancho Calabuig A, CapdevilaPlaza L, Franco Esteve A. Acute rejection, and laterenal transplant failure: risk factors and prognosis.Nephrol Dial Transplant. 2004;19 Suppl 3: iii38–42.

  18. Meier-Kriesche HU, Steen BJ, Hochberg AM,Gordon RD, Liebman MN, Morris JA, et al. Long-Term Use of Mycophenolate Mofetil is Associatedwith a Reduction in the Incidence and Risk of LateRejection. Am J Transplant.2003;3(1):68–73.

  19. Tönsho B. Immunosuppressants in OrganTransplantation. Handb Exp Pharmacol. 2020;261:441-469.

  20. Eun Jeong Ko, Ji Hyun Yu, Chul Woo Yang, Byung HaChung. Korean Organ Transplantation Registry StudyGroup outcomes of ABO- and HLA-incompatiblekidney transplantation: a nationwide cohort study.Transpl Int, 30 (2017), s. 1215-1225.

  21. J. Lee, D.G. Kim, B.S. Kim, M.S. Kim, S. Il Kim,Y.S. Kim, et al. Early hospital readmissions afterABO- or HLA- incompatibleliving donor kidneytransplantation. Sci Rep 2019; 9:3246.

  22. Rabi Yacoub, Girish N Nadkarni, Paolo Cravedi,John Cijiang He, Veronica B Delaney, Rebecca Kent,et al. Analysis of OPTN/UNOS registry suggeststhe number of HLA matches and not mismatches isa stronger independent predictor of kidney transplantsurvival. Kidney Int. 2018; Feb;93(2):482-490.

  23. Kang DH, Nakagawa T. Uric acid, and chronicrenal disease: possible implication of hyperuricemiaon progression of renaldis ease. Semin Nephrol. 2005;25:43.

  24. Farah Bandukwala , Michael Huang, JereyS Zaltzman, Michelle M Nash, G V RameshPrasad. Association of uric acid with inammation,progressive renal allograft dysfunction and post-transplant cardiovascular risk. Am J Cardiol. 2009Mar 15;103(6):867-71.

  25. Gerhardt U, Grosse HM, Hohage H. Inuence ofhyperglycemia and hyperuricemia on long- termtransplant survival in kidney transplant recipients.Clin Transplant 13:375, 1999.




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