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Urinary sulfate excretion and risk of late graft failure in renal transplant recipients - a prospective cohort study

Said, M. Y., Post, A., Minovic, I., Londen, van, M., van Goor, H., Postmus, D., Heiner Fokkema, M. R., Berg ,van den, E., Pasch, A., Navis, G. & Bakker, S., Jul-2020, In : Transplant International. 33, 7, p. 752-761 10 p.

Research output: Contribution to journalArticleAcademicpeer-review

Hydrogen sulfide (H2S), produced from metabolism of dietary sulfur-containing amino acids, is allegedly a renoprotective compound. Twenty-four-hour urinary sulfate excretion (USE) may reflect H2S bioavailability. We aimed to investigate the association of USE with graft failure in a large prospective cohort of renal transplant recipients (RTR). We included 704 stable RTR, recruited at least 1 year after transplantation. We applied log-rank testing and Cox regression analyses to study association of USE, measured from baseline 24 h urine samples, with graft failure. Median age was 55 [45-63] years (57% male, eGFR was 45 +/- 19 ml/min/1.73 m(2)). Median USE was 17.1 [13.1-21.1] mmol/24 h. Over median follow-up of 5.3 [4.5-6.0] years, 84 RTR experienced graft failure. RTR in the lowest sex-specific tertile of USE experienced a higher rate of graft failure during follow-up than RTR in the middle and highest sex-specific tertiles (18%, 13%, and 5%, respectively, log-rankP <0.001). In Cox regression analyses, USE was inversely associated with graft failure [HR per 10 mmol/24 h: 0.37 (0.24-0.55),P <0.001]. The association remained independent of adjustment for potential confounders, including age, sex, eGFR, proteinuria, time between transplantation and baseline, BMI, smoking, and high sensitivity C-reactive protein [HR per 10 mmol/24 h: 0.51 (0.31-0.82),P = 0.01]. In conclusion, this study demonstrates a significant inverse association of USE with graft failure in RTR, suggesting high H2S bioavailability as a novel, potentially modifiable factor for prevention of graft failure in RTR.

Original languageEnglish
Pages (from-to)752-761
Number of pages10
JournalTransplant International
Volume33
Issue number7
Publication statusPublished - Jul-2020

    Keywords

  • chronic graft failure, hydrogen sulfide, protein intake, renal transplantation, ISCHEMIA-REPERFUSION INJURY, HYDROGEN-SULFIDE, BLOOD-PRESSURE, SURVIVAL, NUTRITION, CATECHOLAMINES, ASSOCIATION, PROGRESSION, MORTALITY, PROTEIN

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