Homoarginine and Clinical Outcomes in Renal Transplant Recipients Results From the Assessment of Lescol in Renal Transplantation Study.
Drechsler C, Pihlstrøm H, et al.Transplantation 2015 Jul;99(7):1470-6
Aims
This was a subgroup analysis of the Assessment of Lescol in Renal Transplantation (ALERT) trial, in which the effect of fluvastatin on cardiac and renal outcomes in renal transplant recipients was tested. The subgroup analysis investigated whether a deficiency in homoarginine contributes to renal function decline, cardiovascular, and all-cause mortality in kidney transplant recipients.
Interventions
In the ALERT trial participants were randomised to Fluvastatin or placebo.
Participants
829 of 1052 patients in the placebo arm of the ALERT trial who had available homoarginine measurements. The participants were divided into 4 groups according to quartiles of homoarginine levels at baseline.
Outcomes
Major adverse cardiovascular events, combined cardiac death or nonfatal myocardial infarction, combined cerebrovascular events, noncardiovascular death, all-cause mortality, and the composite renal endpoint of graft loss or doubling of serum creatinine were all chosen as separate outcome measures.
Follow-up
5 to 6 years.
CET Conclusions
This manuscript reports the association between homoarginine levels and clinical outcomes in a subset of renal transplant recipients in the ALERT study. Patients with low homoarginine levels had a significantly higher risk of cerebrovascular events, all-cause mortality, graft loss and progression of renal impairment than those with higher levels. This is an interesting observation, obviously with the caveats of a retrospective analysis. Not all patients in the trial had homoarginine levels available, and whilst the regression analysis corrected for known confounders (including eGFR) there may be other confounders that are not accounted for. Association does not necessarily reflect causation, but the results are interesting and significant enough to support prospective study of homoarginine supplementation in renal transplant patients.
Data analysis
Strict intention-to-treat analysis
Quality notes
Previously assessed as Holdaas, H. et al. Nephrology Dialysis Transplantation 20(5): 974-980. 2005.
Trial registration
Not reported.