PMID- 28371433 OWN - NLM STAT- MEDLINE DCOM- 20180614 LR - 20230124 IS - 1600-6143 (Electronic) IS - 1600-6135 (Print) IS - 1600-6135 (Linking) VI - 17 IP - 10 DP - 2017 Oct TI - Urinary Markers of Fibrosis and Risk of Cardiovascular Events and Death in Kidney Transplant Recipients: The FAVORIT Trial. PG - 2640-2649 LID - 10.1111/ajt.14284 [doi] AB - Cardiovascular risk remains high in kidney transplant recipients (KTRs) despite improved kidney function after transplant. Urinary markers of kidney fibrosis and injury may help to reveal mechanisms of this risk. In a case-cohort study among stable KTRs who participated in the FAVORIT trial, we measured four urinary proteins known to correlate with kidney tubulointerstitial fibrosis on biopsy (urine alpha 1 microglobulin [alpha1m], monocyte chemoattractant protein-1 [MCP-1], procollagen type I [PINP] and type III [PIIINP] N-terminal amino peptide) and evaluated associations with cardiovascular disease (CVD) events (n = 300) and death (n = 371). In adjusted models, higher urine alpha1m (hazard ratio [HR] per doubling of biomarker 1.40 [95% confidence interval [CI] 1.21, 1.62]), MCP-1 (HR 1.18 [1.03, 1.36]), and PINP (HR 1.13 [95% CI 1.03, 1.23]) were associated with CVD events. These three markers were also associated with death (HR per doubling alpha1m 1.51 [95% CI 1.32, 1.72]; MCP-1 1.31 [95% CI 1.13, 1.51]; PINP 1.11 [95% CI 1.03, 1.20]). Higher concentrations of urine alpha1m, MCP-1, and PINP may identify KTRs at higher risk for CVD events and death. These markers may identify a systemic process of fibrosis involving both the kidney and cardiovascular system, and give new insights into mechanisms linking the kidney with CVD. CI - (c) 2017 The American Society of Transplantation and the American Society of Transplant Surgeons. FAU - Park, M AU - Park M AD - Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA. AD - Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA. FAU - Katz, R AU - Katz R AD - Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA. FAU - Shlipak, M G AU - Shlipak MG AD - Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA. AD - General Internal Medicine Section, San Francisco Veterans Affairs Hospital, San Francisco, CA. AD - Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA. FAU - Weiner, D AU - Weiner D AD - Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA. FAU - Tracy, R AU - Tracy R AD - Department of Pathology, University of Vermont, Burlington, VT. FAU - Jotwani, V AU - Jotwani V AD - Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA. FAU - Hughes-Austin, J AU - Hughes-Austin J AD - Division of Preventive Medicine, Department of Preventive Medicine and Public Health, University of California San Diego, San Diego, CA. FAU - Gabbai, F AU - Gabbai F AD - Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA. AD - Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA. FAU - Hsu, C Y AU - Hsu CY AD - Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA. FAU - Pfeffer, M AU - Pfeffer M AD - Division of Cardiology, Brigham and Women's Hospital, Boston, MA. FAU - Bansal, N AU - Bansal N AD - Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA. FAU - Bostom, A AU - Bostom A AD - Rhode Island Hospital, Providence, RI. FAU - Gutierrez, O AU - Gutierrez O AD - Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, AL. FAU - Sarnak, M AU - Sarnak M AD - Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA. FAU - Levey, A AU - Levey A AD - Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA. FAU - Ix, J H AU - Ix JH AD - Division of Preventive Medicine, Department of Preventive Medicine and Public Health, University of California San Diego, San Diego, CA. AD - Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA. AD - Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA. LA - eng GR - K23 DK109868/DK/NIDDK NIH HHS/United States GR - R01 DK098234/DK/NIDDK NIH HHS/United States GR - K24 DK110427/DK/NIDDK NIH HHS/United States GR - K23 DK099238/DK/NIDDK NIH HHS/United States GR - K24 DK092291/DK/NIDDK NIH HHS/United States GR - U01 DK061700/DK/NIDDK NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial DEP - 20170426 PL - United States TA - Am J Transplant JT - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons JID - 100968638 RN - 0 (Biomarkers) RN - 935E97BOY8 (Folic Acid) SB - IM MH - Aged MH - Biomarkers/*urine MH - Cardiovascular Diseases/epidemiology/prevention & control/*urine MH - Case-Control Studies MH - Female MH - Fibrosis MH - Folic Acid/administration & dosage MH - Humans MH - *Kidney Transplantation/mortality MH - Male MH - Middle Aged MH - Nephritis, Interstitial/*urine MH - Risk Factors PMC - PMC5620109 MID - NIHMS863873 OTO - NOTNLM OT - biomarker OT - cardiovascular disease OT - clinical research/practice OT - kidney disease OT - kidney transplantation/nephrology COIS- Disclosure: The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation. EDAT- 2017/04/04 06:00 MHDA- 2018/06/15 06:00 PMCR- 2018/10/01 CRDT- 2017/04/04 06:00 PHST- 2016/11/13 00:00 [received] PHST- 2017/03/13 00:00 [revised] PHST- 2017/03/18 00:00 [accepted] PHST- 2017/04/04 06:00 [pubmed] PHST- 2018/06/15 06:00 [medline] PHST- 2017/04/04 06:00 [entrez] PHST- 2018/10/01 00:00 [pmc-release] AID - S1600-6135(22)25169-7 [pii] AID - 10.1111/ajt.14284 [doi] PST - ppublish SO - Am J Transplant. 2017 Oct;17(10):2640-2649. doi: 10.1111/ajt.14284. Epub 2017 Apr 26.