Table 4.
Hazard/odds ratio (95% confidence intervals) of post-transplant all-cause, cardiovascular, and infectious death or graft failure, delayed graft function, or acute rejection comparing pretransplant serum iPTH categories (150–<300 pg/ml the reference) using Cox regression and logistic regression analyses in 10,107 dialysis patients who underwent renal transplantation and observed for up to 6 years (July 2001–June 2007)
| Pretransplant Serum iPTH Level (pg/ml) | Unadjusted | Case-Mix Adjusteda | MMI Adjustedb | Transplant Data Adjustedc | ||||
|---|---|---|---|---|---|---|---|---|
| HR (95% CI) | P Value | HR (95% CI) | P Value | HR (95% CI) | P Value | HR (95% CI) | P Value | |
| Graft failure censored all-cause death | ||||||||
| n | 10,107 | 8082 | 7820 | 4852 | ||||
| <150 | 1.05 (0.86–1.28) | 0.63 | 0.99 (0.79–1.26) | 0.97 | 1.04 (0.82–1.33) | 0.72 | 1.06 (0.79–1.41) | 0.70 |
| 150–<300 | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A |
| 300–<500 | 0.90 (0.75–1.08) | 0.24 | 0.99 (0.81–1.22) | 0.94 | 0.98 (0.79–1.21) | 0.83 | 1.12 (0.88–1.44) | 0.36 |
| 500–<800 | 0.72 (0.56–0.92) | 0.01 | 0.98 (0.74–1.29) | 0.87 | 1.02 (0.76–1.37) | 0.88 | 1.15 (0.81–1.63) | 0.43 |
| ≥800 | 0.79 (0.61–1.03) | 0.08 | 1.22 (0.90–1.66) | 0.21 | 1.27 (0.92–1.75) | 0.14 | 1.28 (0.87–1.88) | 0.20 |
| Graft failure censored cardiovascular death | ||||||||
| <150 | 1.17 (0.77–1.78) | 0.46 | 1.09 (0.66–1.80) | 0.72 | 1.02 (0.61–1.72) | 0.94 | 1.00 (0.54–1.87) | 0.99 |
| 150–<300 | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A |
| 300–<500 | 1.12 (0.78–1.63) | 0.53 | 1.08 (0.71–1.64) | 0.74 | 1.03 (0.67–1.58) | 0.88 | 1.04 (0.67–1.80) | 0.79 |
| 500–<800 | 1.52 (1.01–2.28) | 0.04 | 1.81 (1.14–2.89) | 0.01 | 1.70 (1.03–2.79) | 0.04 | 2.21 (1.24–3.91) | 0.007 |
| ≥800 | 1.19 (0.74–1.91) | 0.47 | 1.31 (0.72–2.39) | 0.37 | 1.29 (0.70–2.38) | 0.41 | 1.21 (0.58–2.54) | 0.62 |
| Graft failure censored infectious death | ||||||||
| <150 | 1.32 (0.86–2.03) | 0.20 | 0.96 (0.57–1.63) | 0.89 | 0.97 (0.56–1.67) | 0.90 | 1.16 (0.59–2.29) | 0.66 |
| 150–<300 | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A |
| 300–<500 | 1.03 (0.69–1.54) | 0.89 | 0.93 (0.58–1.48) | 0.76 | 0.94 (0.58–1.52) | 0.80 | 1.18 (0.64–2.16) | 0.59 |
| 500–<800 | 0.92 (0.55–1.54) | 0.75 | 1.03 (0.55–1.91) | 0.93 | 1.05 (0.55–1.99) | 0.89 | 1.45 (0.66–3.19) | 0.36 |
| ≥800 | 1.07 (0.63–1.81) | 0.82 | 1.51 (0.78–2.91) | 0.22 | 1.52 (0.77–2.99) | 0.23 | 1.52 (0.62–3.70) | 0.36 |
| All-cause death censored graft failure | ||||||||
| <150 | 0.88 (0.72–1.08) | 0.21 | 0.88 (0.68–1.14) | 0.34 | 0.87 (0.66–1.14) | 0.31 | 0.99 (0.70–1.41) | 0.96 |
| 150–<300 | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A |
| 300–<500 | 1.43 (1.23–1.67) | <0.001 | 1.24 (1.04–1.49) | 0.02 | 1.25 (1.04–1.51) | 0.02 | 1.42 (1.11–1.82) | 0.005 |
| 500–<800 | 1.34 (1.12–1.61) | 0.002 | 1.07 (0.85–1.35) | 0.58 | 1.03 (0.81–1.31) | 0.82 | 1.26 (0.93–1.72) | 0.14 |
| ≥800 | 2.10 (1.77–2.49) | <0.001 | 1.11 (0.87–1.42) | 0.40 | 1.07 (0.83–1.38) | 0.59 | 1.10 (0.79–1.55) | 0.57 |
| Delayed graft function | ||||||||
| n | 9592 | 7705 | 7457 | 4852 | ||||
| <150 | 0.90 (0.77–1.06) | 0.21 | 1.06 (0.88–1.27) | 0.52 | 1.10 (0.91–1.33) | 0.31 | 1.14 (0.91–1.41) | 0.26 |
| 150–<300 | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A |
| 300–<500 | 1.12 (0.99–1.27) | 0.08 | 1.12 (0.97–1.29) | 0.13 | 1.09 (0.94–1.27) | 0.24 | 1.10 (0.93–1.30) | 0.29 |
| 500–<800 | 1.04 (0.89–1.22) | 0.60 | 1.01 (0.84–1.22) | 0.90 | 0.94 (0.77–1.14) | 0.50 | 0.97 (0.77–1.21) | 0.78 |
| ≥800 | 1.23 (1.04–1.45) | 0.01 | 1.26 (1.03–1.54) | 0.03 | 1.14 (0.92–1.41) | 0.23 | 1.03 (0.80–1.32) | 0.82 |
| Acute rejection | ||||||||
| n | 4985 | 4209 | 4123 | 2793 | ||||
| <150 | 1.51 (0.95–2.40) | 0.08 | 1.35 (0.78–2.32) | 0.28 | 1.37 (0.79–2.37) | 0.26 | 1.27 (0.65–2.51) | 0.49 |
| 150–<300 | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A | 1.00 | N/A |
| 300–<500 | 1.51 (1.05–2.18) | 0.03 | 1.48 (0.99–2.22) | 0.06 | 1.46 (0.97–2.20) | 0.07 | 1.25 (0.76–2.05) | 0.38 |
| 500–<800 | 1.41 (0.91–2.21) | 0.13 | 1.26 (0.75–2.11) | 0.38 | 1.21 (0.72–2.04) | 0.48 | 1.01 (0.52–2.00) | 0.97 |
| ≥800 | 1.53 (0.95–2.46) | 0.08 | 1.20 (0.67–2.16) | 0.54 | 1.07 (0.58–1.99) | 0.82 | 1.41 (0.70–2.85) | 0.34 |
iPTH, intact parathyroid hormone; MMI, markers of malnutrition or inflammation; HR, hazard ratio; 95% CI, 95% confidence interval.
Adjusted for age, sex, recipient race/ethnicity, diabetes mellitus, dialysis vintage, primary insurance, marital status, standardized mortality ratio of the dialysis clinic during entry quarter, dialysis dose as indicated by Kt/V (single pool), presence or absence of a hemodialysis catheter, and residual renal function during the entry quarter and eight comorbidities.
Adjusted for all of the covariates plus body mass index, normalized protein nitrogen appearance , serum or blood concentrations of total iron-binding capacity, ferritin, phosphorous, calcium, bicarbonate, peripheral white blood cell count, lymphocyte percentage, and albumin.
Adjusted for all of the above plus donor type, donor age, donor sex, panel reactive antibody titer (last value before transplant), number of HLA mismatches, cold ischemia time, delayed graft function (except when delayed graft function was a dependent variable in our logistic regression models), and extended donor criteria.