Abstract: TH-PO0910
Is Albuminuria as Strong a Risk Factor for Renal and Nonrenal Adverse Outcomes in Kidney Transplant Recipients as It Is in Native CKD?
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Hwang, Jin Ho, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Korea (the Republic of)
- Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
Background
Albuminuria is a well-known predictor of kidney failure, CVD, and mortality in CKD. However, its significance in kidney transplant recipients is less well characterized and albuminuria is rarely measured in this population. We compared the strengths of association between albuminuria and adverse outcomes in native CKD and transplant recipients to explore its implications.
Methods
We analyzed participants from the Folic Acid for Vascular Outcomes Reduction in Transplantation (FAVORIT) trial and the Chronic Renal Insufficiency Cohort (CRIC). Baseline UACR was log2-transformed. Cox models assessed the association between albuminuria and outcomes of composite CVD (stroke, MI, and peripheral artery disease), all-cause mortality, and kidney (allograft) failure, incorporating an interaction term(log2UACR*Cohort) to test for differing effects between cohorts.
Results
FAVORIT participants had lower UACR and higher eGFR than CRIC participants. Over 5 years, FAVORIT had higher rates of CVD and mortality, while kidney (allograft) failure was more common in CRIC. Each doubling of UACR was independently associated with increased risk for CVD (HR 1.08, 95% CI 1.04–1.11), mortality (HR 1.15, 95% CI 1.11–1.20), and kidney (allograft) failure (HR 1.38, 95% CI 1.32–1.45)(all p<0.001). UACR had comparable effect sizes across cohorts, except for mortality, where the association was actually stronger in FAVORIT (Table).
Conclusion
Albuminuria predicts adverse outcomes in transplant recipients similarly to native CKD. These results suggest that albuminuria from the allograft reflect the recipient’s systemic milieu and support more UACR monitoring among transplant recipients which would be a change from current practice.
Results of Cox regression for CVD, Mortality, and kidney (allograft) failure HR (95% CI)
| CVD | Mortality | Kidney (allograft) failure | |
| Per doubling of UACR (log2UACR) | 1.08 (1.04-1.11) | 1.15 (1.11-1.20) | 1.38 (1.32-1.45) |
| log2UACR * Cohort | 1.02 (0.97-1.06) | 0.95 (0.91-0.999) | 1.05 (0.99-1.11) |
| CRIC Cohort (FAVORIT as reference) | 0.36 (0.26-0.51) | 0.65 (0.46-0.93) | 0.62 (0.37-1.05) |
| Age (per year) | 1.03 (1.02-1.03) | 1.04 (1.03-1.05) | 0.98 (0.97-0.98) |
| Female (Male as reference) | 0.77 (0.67-0.89) | 0.84 (0.72-0.97) | 0.68 (0.59-0.78) |
| White (Nonwhite as reference) | 1.11 (0.96-1.29) | 0.93 (0.80-1.07) | 0.91 (0.79-1.05) |
| CKD-EPI 2021 eGFR (per 1 ml/min/1.73m2) | 0.99 (0.98-0.99) | 0.99 (0.98-0.99) | 0.93 (0.93-0.94) |
| Diabetes (yes vs. no) | 1.99 (1.72-2.30) | 1.49 (1.29-1.72) | 1.27 (1.09-1.46) |
| History of CVD (yes vs. no) | 2.26 (1.97-2.60) | 1.89 (1.64-2.18) | 1.16 (1.00-1.34) |
| Systolic BP (per 1 mmHg) | 1.01 (1.00-1.01) | 1.00 (1.00-1.01) | 1.01 (1.01-1.01) |
Funding
- NIDDK Support