Kidney Week

Abstract: PO2424

Defining a Minimal Clinically Meaningful Difference (MCMD) in Estimated Glomerular Filtration Rate (eGFR) for Kidney Transplantation

Session Information

• Clinical and Immunologic Predictors of Post-Transplant Outcomes
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Mayne, Tracy J., Angion Biomedica, San Francisco, California, United States

Tracy J. Mayne,

• Mohan, Sumit, Columbia University, New York, New York, United States

Sumit Mohan,

• Schold, Jesse D., Cleveland Clinic, Cleveland, Ohio, United States

Jesse D. Schold,

• Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States

Matthew R. Weir,

• Nordyke, Bob, Angion Biomedica, San Francisco, California, United States

Bob Nordyke,

Background

eGFR is an established measure of renal function & predicts clinical outcomes. A MCMD for eGFR has never been clearly defined.

Methods

Data source: United Network for Organ Sharing (OPTN) database
Study population: Adults (>18 years of age); received deceased donor kidney 01/01/2013 to 12/31/2018; multi-organ & non-incident transplants were excluded.
Analysis: Cox proportional hazards regression
Primary outcome: Death-censored graft survival starting 12-months post-transplantation.
Predictors: Recipient (gender, age, race, diabetes, body mass index, panel reactive antibodies); Donor (age, diabetes, hypertension, proteinuria); Transplantation (cold ischemia time, pump, DR locus mismatch, delayed graft function); 12-month eGFR (CKD-EPI).
Analysis. eGFR was stratified by bands of 5, 7 or 10 mL/min/1.73m². Regressions compared each band to the next sequential band. A weighted mean hazard ratio was calculated using OPTN population eGFR distribution.

Results

The relationship between 12-month eGFR & graft failure is non-linear: HR=~3 to 4 at eGFR <15 mL/min/1.73m²; HR=~1.1 at eGFRs > 55. Mean HR=1.47 for 10 mL/min/1.73m² bands; 1.30 at 7 mL; 1.19 at 5 mL.

Conclusion

Controlling for multiple factors, 12-month eGFR is a strong predictor of death-censored graft survival. Mean HR (1.19) is consistent with an effect size considered significant, clinically meaningful, & supporting of regulatory approval (eg, angiotensin receptor blockers; statins). This supports 5 mL/min/1.73m² as the eGFR MCMD in kidney transplantation.

DISCLAIMER. The interpretation & reporting of these data are the responsibility of the authors & in no way should be seen as an official policy of or interpretation by the OPTN or the US Government.