Prevalence of proteinuria after living donor kidney transplantation and related risk factors: A retrospective cohort study from Syria

Introduction

proteinuria is associated with poor allograft and patient survival in kidney transplant recipients (KTRs). This study aims to investigate the prevalence and risk factors of proteinuria in KTRs and its impact on kidney function during the first two years after kidney transplantation (KT).

Materials and methods

200 KTRs were included in this retrospective cohort study from living donors, performed in two University hospitals in Syria, from January 2018 to March 2021. Demographic and immunological characteristics were analyzed depending on the 24 h urine protein (Up) excretion that was classified into three groups: Up I (150–500 mg/day), Up II between (0.5–1 g/day), and Up III (>1 g/day).

Results

Up was increased subsequently as the transplant progressed, where the greatest excretion of the Up was reported 2 years after KT. At 6 months after KT; the cold ischemic time (CIT), serum creatinine (Cr), using angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin II receptor blockers (ARBs), and GFR showed strong significant differences between Up groups (P = 0.00003, 0.0001, 0.00001, and 0.026; respectively). The CIT and Cr were higher in the Up III group compared to Up I and UP II groups. At 12 months after KT; Cr, using ACEIs/ARBs, and GFR showed strong significant differences between Up groups (P = 0.00009, <0.0001, and <0.0001; respectively). The mean Cr was higher in Up II and Up III groups (1.7 mg/dL; for each) compared to the Up I group (1.0 mg/dL). At 24 months after KT; CIT, using ACEIs/ARBs, Cr, and GFR showed strong significant differences between Up groups (P = 0.02, <0.0001, 0.00008, and <0.0001; respectively).

Conclusion

This is the first study from Syria that conducted in KT patients. The prevalence and amount of proteinuria showed subsequently increased as the transplant progressed. Serum Cr, GFR, CIT, and using ACEIs/ARBs showed differences between Up groups at 6 months, 1 year, and 2 years after KT. Our data suggest that the use of ACEIs/ARBs is not a contraindication in early posttransplant period. Due to several known cardiovascular and renal benefits of ACEIs/ARBs future studied in KT population should investigated to determine if these drugs could give beneficial effects on grafts and patients survival.