Poor Predictive Value of Serum Creatinine for Renal Allograft Loss

Bruce Kaplan, Jesse Schold, Herwig Ulf Meier-Kriesche

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

Both medical care and pharmaceutical development have led to an increase in expected graft and patient survival for patients who undergo renal transplantation. From a research perspective, it has become increasingly difficult to study the efficacy of new therapies using traditional 'hard' endpoints. In reaction to this dilemma, the transplant community has sought a surrogate endpoint. A natural candidate for a surrogate marker for graft loss that has been proposed is renal function (serum creatinine or calculated GFR levels). Using data from the USRDS, we conducted a retrospective evaluation of transplant data from 1988 to 1999 to quantify the predictive value of renal function for the outcomes of graft loss, death-censored graft loss, and patient death. Renal function along with the change in renal function demonstrated a high relative risk for ultimate graft survival and graft loss (odds ratio = 2.2 for an increase of 1 mg/dL). However, the predictive value as measured by the area under the receiver operating characteristic curve (AUC) for this criteria was poor (0.627). These findings held true for the slope of creatinine and formulations of GFR. While renal function is a strong risk factor and highly correlated with graft failure, the utility of renal function as a predictive tool for graft loss is limited.

Original languageEnglish (US)
Pages (from-to)1560-1565
Number of pages6
JournalAmerican Journal of Transplantation
Volume3
Issue number12
DOIs
StatePublished - Dec 2003
Externally publishedYes

Fingerprint

Allografts
Creatinine
Transplants
Kidney
Serum
Graft Survival
Biomarkers
Pharmaceutical Services
ROC Curve
Kidney Transplantation
Area Under Curve
Renal Insufficiency
Odds Ratio
Research

Keywords

  • Creatinine
  • Renal function
  • Transplant

ASJC Scopus subject areas

  • Immunology

Cite this

Poor Predictive Value of Serum Creatinine for Renal Allograft Loss. / Kaplan, Bruce; Schold, Jesse; Meier-Kriesche, Herwig Ulf.

In: American Journal of Transplantation, Vol. 3, No. 12, 12.2003, p. 1560-1565.

Research output: Contribution to journalArticle

Kaplan, Bruce ; Schold, Jesse ; Meier-Kriesche, Herwig Ulf. / Poor Predictive Value of Serum Creatinine for Renal Allograft Loss. In: American Journal of Transplantation. 2003 ; Vol. 3, No. 12. pp. 1560-1565.
@article{d69bbbfaaf804de6899c72c255b8c2a3,
title = "Poor Predictive Value of Serum Creatinine for Renal Allograft Loss",
abstract = "Both medical care and pharmaceutical development have led to an increase in expected graft and patient survival for patients who undergo renal transplantation. From a research perspective, it has become increasingly difficult to study the efficacy of new therapies using traditional 'hard' endpoints. In reaction to this dilemma, the transplant community has sought a surrogate endpoint. A natural candidate for a surrogate marker for graft loss that has been proposed is renal function (serum creatinine or calculated GFR levels). Using data from the USRDS, we conducted a retrospective evaluation of transplant data from 1988 to 1999 to quantify the predictive value of renal function for the outcomes of graft loss, death-censored graft loss, and patient death. Renal function along with the change in renal function demonstrated a high relative risk for ultimate graft survival and graft loss (odds ratio = 2.2 for an increase of 1 mg/dL). However, the predictive value as measured by the area under the receiver operating characteristic curve (AUC) for this criteria was poor (0.627). These findings held true for the slope of creatinine and formulations of GFR. While renal function is a strong risk factor and highly correlated with graft failure, the utility of renal function as a predictive tool for graft loss is limited.",
keywords = "Creatinine, Renal function, Transplant",
author = "Bruce Kaplan and Jesse Schold and Meier-Kriesche, {Herwig Ulf}",
year = "2003",
month = "12",
doi = "10.1046/j.1600-6135.2003.00275.x",
language = "English (US)",
volume = "3",
pages = "1560--1565",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - Poor Predictive Value of Serum Creatinine for Renal Allograft Loss

AU - Kaplan, Bruce

AU - Schold, Jesse

AU - Meier-Kriesche, Herwig Ulf

PY - 2003/12

Y1 - 2003/12

N2 - Both medical care and pharmaceutical development have led to an increase in expected graft and patient survival for patients who undergo renal transplantation. From a research perspective, it has become increasingly difficult to study the efficacy of new therapies using traditional 'hard' endpoints. In reaction to this dilemma, the transplant community has sought a surrogate endpoint. A natural candidate for a surrogate marker for graft loss that has been proposed is renal function (serum creatinine or calculated GFR levels). Using data from the USRDS, we conducted a retrospective evaluation of transplant data from 1988 to 1999 to quantify the predictive value of renal function for the outcomes of graft loss, death-censored graft loss, and patient death. Renal function along with the change in renal function demonstrated a high relative risk for ultimate graft survival and graft loss (odds ratio = 2.2 for an increase of 1 mg/dL). However, the predictive value as measured by the area under the receiver operating characteristic curve (AUC) for this criteria was poor (0.627). These findings held true for the slope of creatinine and formulations of GFR. While renal function is a strong risk factor and highly correlated with graft failure, the utility of renal function as a predictive tool for graft loss is limited.

AB - Both medical care and pharmaceutical development have led to an increase in expected graft and patient survival for patients who undergo renal transplantation. From a research perspective, it has become increasingly difficult to study the efficacy of new therapies using traditional 'hard' endpoints. In reaction to this dilemma, the transplant community has sought a surrogate endpoint. A natural candidate for a surrogate marker for graft loss that has been proposed is renal function (serum creatinine or calculated GFR levels). Using data from the USRDS, we conducted a retrospective evaluation of transplant data from 1988 to 1999 to quantify the predictive value of renal function for the outcomes of graft loss, death-censored graft loss, and patient death. Renal function along with the change in renal function demonstrated a high relative risk for ultimate graft survival and graft loss (odds ratio = 2.2 for an increase of 1 mg/dL). However, the predictive value as measured by the area under the receiver operating characteristic curve (AUC) for this criteria was poor (0.627). These findings held true for the slope of creatinine and formulations of GFR. While renal function is a strong risk factor and highly correlated with graft failure, the utility of renal function as a predictive tool for graft loss is limited.

KW - Creatinine

KW - Renal function

KW - Transplant

UR - http://www.scopus.com/inward/record.url?scp=0346752037&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0346752037&partnerID=8YFLogxK

U2 - 10.1046/j.1600-6135.2003.00275.x

DO - 10.1046/j.1600-6135.2003.00275.x

M3 - Article

VL - 3

SP - 1560

EP - 1565

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 12

ER -