Kasiske et al evaluated different methods for predicting late renal allograft failure. These can help identify a patient who may benefit from more aggressive management to prevent rejection. The authors are from the Hennepin County Medical Center in Minneapolis, Hospital Juan Canalejo in La Coruna and Hospital Universitario de Canarias in Tenerife, Spain.


Factors associated with a poor prognosis for a renal allograft:

(1) a change in 1/Cr (delta 1/Cr) < -40% (relative risk 5.9)

(2) estimated creatinine clearance using the Cockcroft-Gault equation < 45 mL/min (relative risk 3.5)


The equation for delta 1/Cr is:


change in 1/Cr =

= ((1/ (followup serum creatinine)) - (1 / (previous serum creatinine))) / (1 / (previous serum creatinine))


This can be rearranged to


change in 1/Cr in percent =

= ((previous serum creatinine) - (followup serum creatinine)) / (previous serum creatinine) * 100%



• Variables for the Cockcroft-Gault equation (use of ideal vs actual body weight, adjustment to 1.73 meter square BSA) were not specified. For the implementation I have used both use of ideal body weight and adjustment to 1.73 square meter BSA.

• A change in 1/Cr < -30% had a relative risk close to 5.


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