Calcification Propensity (T50) Predicts a Rapid Decline of Renal Function in Kidney Transplant Recipients

Nathalie Hammer; David Legouis; Andreas Pasch; Aurélie Huber; Lama Al-Qusairi; Pierre-Yves Martin; Sophie de Seigneux; Lena Berchtold

doi:10.3390/jcm12123965

Calcification Propensity (T50) Predicts a Rapid Decline of Renal Function in Kidney Transplant Recipients

J Clin Med. 2023 Jun 10;12(12):3965. doi: 10.3390/jcm12123965.

Authors

Nathalie Hammer¹, David Legouis², Andreas Pasch^{3

4}, Aurélie Huber⁵, Lama Al-Qusairi⁶, Pierre-Yves Martin⁷, Sophie de Seigneux⁷, Lena Berchtold⁷

Affiliations

¹ Service of Nephrology, Inselspital, 3010 Bern, Switzerland.
² Division of Intensive Care, University Hospital of Geneva, 1205 Geneva, Switzerland.
³ Calciscon AG, 2503 Biel, Switzerland.
⁴ Department of Physiology and Pathophysiology, Johannes Kepler University, 4040 Linz, Austria.
⁵ Service of Internal Medicine, Hospital La Chaux-de-Fonds, 2000 Neuchatel, Switzerland.
⁶ Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA.
⁷ Service of Nephrology, Department of Internal Medicine Specialties, University Hospital of Geneva, 1205 Geneva, Switzerland.

Abstract

Background: Serum creatinine level, proteinuria, and interstitial fibrosis are predictive of renal prognosis. Fractional excretion of phosphate (FEP)/FGF23 ratio, tubular reabsorption of phosphate (TRP), serum calcification propensity (T50), and Klotho's serum level are emerging as determinants of poor kidney outcomes in CKD patients. We aimed at analysing the use of FGF23, FEP/FGF23, TRP, T50, and Klotho in predicting the rapid decline of renal function in kidney allograft recipients.

Methods: We included 103 kidney allograft recipients in a retrospective study with a prospective follow-up of 4 years. We analysed the predictive values of FGF23, FEP/FGF23, TRP, T50, and Klotho for a rapid decline of renal function defined as a drop of eGFR > 30%.

Results: During a follow-up of 4 years, 23 patients displayed a rapid decline of renal function. Tertile of FGF23 (p value = 0.17), FEP/FGF23 (p value = 0.78), TRP (p value = 0.62) and Klotho (p value = 0.31) were not associated with an increased risk of rapid decline of renal function in kidney transplant recipients. The lower tertile of T50 was significantly associated with eGFR decline >30% with a hazard ratio of 3.86 (p = 0.048) and remained significant in multivariable analysis.

Conclusion: T50 showed a strong association with a rapid decline of renal function in kidney allograft patients. This study underlines its role as an independent biomarker of loss of kidney function. We found no association between other phosphocalcic markers, such as FGF23, FEP/FGF23, TRP and Klotho, with a rapid decline of renal function in kidney allograft recipients.

Keywords: decline of renal function; kidney transplant; phosphocalcic markers; prediction.

Grants and funding

This work was funded by grants from NCCR kidney.ch to S.d.S. and A.P. and Swiss National Foundation to S.d.S. (320030_204187/1) and to LB (PZ00P3_208670). L.B was funded by a grant Projet de Recherche et développement (PRD) from the University hospital of Geneva (PRD 19-2018) and by the research fund of the department of Internal Medicine of the University Hospital and the Faculty of Medicine of Geneva.