Kidney Transplantation Clinical Trial
Official title:
Evaluation of Serum and Urinary C-terminal Agrin Fragment-22 (CAF22) as Novel Renal Function Marker in Kidney Transplant Recipients - A Prospective Observational Study
Established markers of kidney function, such as creatinine, have considerable limitations in
the diagnosis of delayed graft function (DGF) after kidney transplantation (KT). Indeed,
creatinine does not accurately reflect minor changes of renal function as its levels change
only upon significant fluctuations of the latter. CAF22 is a molecule which arises from the
degradation of a larger protein and it is proposed to be a reliable and more sensitive marker
of renal function. This study aims to further clarify this issue by measuring blood and urine
concentrations of CAF22 and comparing them with creatinine levels before and after KT.
The main assumption is that blood CAF22 levels could serve as a more sensitive kidney
function biomarker than creatinine post-KT to detect DGF.
Background
Kidney transplantation (KT) is the most appropriate therapy of end stage renal disease
(ESRD). While the number of kidney donors remained stable during the last decade the number
of patients waiting for a kidney transplantation are rapidly increasing resulting in
utilization of an increasing numbers of marginal renal transplants. These kidneys show a
relatively high percentage of delayed graft function (DGF), which complicates post-transplant
management and increases both the duration of initial hospitalization and the cost of
transplantation.
Exact measurement of glomerular filtration rate (GFR) is complex in the clinical setting and
thus GFR is usually estimated from serum creatinine levels through creatinine-based equations
such as the MDRD or the CKD-EPI equations. Particularly, this is the case in kidney
recipients with DGF, in whom creatinine levels remain high and they have to undergo dialysis.
Creatinine is dialyzable, so that it cannot reflect the actual renal function in this setting
due to fluctuations of its levels. Thus there is emergent need for a more accurate renal
biomarker.
CAF22 is the C-terminal 22 kDa domain of agrin. Agrin is cleaved by its specific protease
neurotrypsin at two distinct sites, whereas cleavage at the beta site generates a 22 kDa
C-terminal fragment (CAF22). In the kidney agrin is part of the basal lamina, where it is the
major contributor of the anionic potential of the glomerular basement membrane (GBM). There
are indices for a proteolytic activity selectively shedding the C-terminal part of agrin of
the GBM. Recently, a 19-fold increase of CAF22 levels in ESDR was observed, which was reduced
in patients receiving KT, qualifying CAF22 as effective renal function marker. Additionally,
current data support that CAF22 levels are not influenced by inflammatory processes, steroids
or by hemodialysis with a standard dialysis membrane.
Objective
Primary:
- to compare CAF22 versus creatinine as biomarkers for DGF prediction in patients undergoing
kidney transplantation
Secondary:
- to evaluate the kinetics of CAF levels related with the graft function outcomes
"immediate graft function (IGF)" and "delayed graft function (DGF)"
- to elucidate whether CAF can make estimations on the required hemodialysis days of
patients with delayed graft function
Methods
Research project with humans associated with the collection of biologic material and
health-related data. Prospective, observational trial.
All patients will be screened consecutively before undergoing kidney transplantation (KT).
All participants will undergo blood and urine sampling for estimation of CAF22 levels once
before KT, once daily during the first 7 days after KT as well as at 2, 4 and 12 weeks after
KT. Blood and urine sampling for CAF22 will be performed during routine follow-up sampling.
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