[Glomerular filtration rate before death, in patients who died with a functioning kidney graft].

BACKGROUND: Death with a functioning kidney graft is now the leading cause of graft loss after renal transplantation.

AIM: To determine if renal function at the last outpatient visit before the recipient’s death was different according to the following causes of death: infections, cardiovascular diseases, gastrointestinal disorders or cancer.

PATIENTS AND METHODS: Retrospective cooperative cohort study conducted in two kidney transplant centers. All patients who received a kidney graft in the last 32 years were included. During that lapse, 431 kidney transplants were performed. Among them, 85 patients died with a functioning graft and were classified due to their cause of death. Glomerular filtration rate (eGFR) was estimated with the Modification of Diet in Renal Disease formula. Declining renal function was defined as a > 20% decline in eGFR during the last 6 months prior to the last outpatient visit.

RESULTS: Eighty four patients were included in the analysis. Of these, 28.2% died of cardiovascular causes, 35.3% of infectious diseases, 15.3% of cancer and 20% of digestive diseases. Patients dying from cancer had a significantly higher eGFR prior to death than those who died from cardiovascular causes, infectious and digestive diseases (p < 0.01). Declining renal function occurred in 34.8% of deaths from cardiovascular causes, 39.3% from infectious diseases, 16.7% from cancer and 40% from digestive diseases. There were no significant differences between groups.

CONCLUSIONS: Kidney graft recipients who die with a functioning graft have better renal function prior to their death when it is due to cancer than when it originates from infectious, cardiovascular or digestive diseases. Declining renal function is similar in the four groups of death causes.