Association of Circulating Trimethylamine <i>N</i>-Oxide and Its Dietary Determinants with the Risk of Kidney Graft Failure: Results of the TransplantLines Cohort Study
Background. Due to the critical shortage of kidneys for transplantation, the identification of modifiable factors related to graft failure is highly desirable. The role of trimethylamine-<i>N</i>-oxide (TMAO) in graft failure remains undetermined. Here, we investigated the clinical utili...
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MDPI AG
2021-01-01
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| Online Access: | https://www.mdpi.com/2072-6643/13/1/262 |
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| author | Jose L. Flores-Guerrero Maryse C. J. Osté Paula B. Baraldi Margery A. Connelly Erwin Garcia Gerjan Navis Stephan J. L. Bakker Robin P. F. Dullaart |
| author_facet | Jose L. Flores-Guerrero Maryse C. J. Osté Paula B. Baraldi Margery A. Connelly Erwin Garcia Gerjan Navis Stephan J. L. Bakker Robin P. F. Dullaart |
| author_sort | Jose L. Flores-Guerrero |
| collection | DOAJ |
| description | Background. Due to the critical shortage of kidneys for transplantation, the identification of modifiable factors related to graft failure is highly desirable. The role of trimethylamine-<i>N</i>-oxide (TMAO) in graft failure remains undetermined. Here, we investigated the clinical utility of TMAO and its dietary determinants for graft failure prediction in renal transplant recipients (RTRs). Methods. We included 448 RTRs who participated in the TransplantLines Cohort Study. Cox proportional-hazards regression analyses were performed to study the association of plasma TMAO with graft failure. Net Benefit, which is a decision analysis method, was performed to evaluate the clinical utility of TMAO and dietary information in the prediction of graft failure. Results. Among RTRs (age 52.7 ± 13.1 years; 53% males), the baseline median TMAO was 5.6 (3.0–10.2) µmol/L. In multivariable regression analysis, the most important dietary determinants of TMAO were egg intake (Std. β = 0.09 [95%CI, 0.01; 0.18]; <i>p</i> = 0.03), fiber intake (Std. β = −0.14 [95%CI, −0.22, −0.05]; <i>p</i> = 0.002), and fish and seafood intake (Std. β = 0.12 [95%CI, 0.03,0.21]; <i>p</i> = 0.01). After a median follow-up of 5.3 (4.5–6.0) years, graft failure was observed in 58 subjects. TMAO was associated with an increased risk of graft failure, independent of age, sex, the body mass index (BMI), blood pressure, lipids, albuminuria, and the Estimated Glomerular Filtration Rate (eGFR) (Hazard Ratio per 1-SD increase of TMAO, 1.62 (95% confidence interval (CI): 1.22; 2.14, <i>p</i> < 0.001)). A TMAO and dietary enhanced prediction model offered approximately double the Net Benefit compared to a previously reported, validated prediction model for future graft failure, allowing the detection of 21 RTRs per 100 RTRs tested, with no false positives versus 10 RTRs, respectively. Conclusions. A predictive model for graft failure, enriched with TMAO and its dietary determinants, yielded a higher Net Benefit compared with an already validated model. This study suggests that TMAO and its dietary determinants are associated with an increased risk of graft failure and that it is clinically meaningful. |
| first_indexed | 2024-03-09T04:24:01Z |
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| last_indexed | 2024-03-09T04:24:01Z |
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| spelling | doaj.art-842b7ceea531495f9ab321ab2376874c2023-12-03T13:42:38ZengMDPI AGNutrients2072-66432021-01-0113126210.3390/nu13010262Association of Circulating Trimethylamine <i>N</i>-Oxide and Its Dietary Determinants with the Risk of Kidney Graft Failure: Results of the TransplantLines Cohort StudyJose L. Flores-Guerrero0Maryse C. J. Osté1Paula B. Baraldi2Margery A. Connelly3Erwin Garcia4Gerjan Navis5Stephan J. L. Bakker6Robin P. F. Dullaart7Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The NetherlandsDepartment of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The NetherlandsDepartment of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The NetherlandsLaboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USALaboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USADepartment of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The NetherlandsDepartment of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The NetherlandsDepartment of Internal Medicine, Division of Endocrinology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The NetherlandsBackground. Due to the critical shortage of kidneys for transplantation, the identification of modifiable factors related to graft failure is highly desirable. The role of trimethylamine-<i>N</i>-oxide (TMAO) in graft failure remains undetermined. Here, we investigated the clinical utility of TMAO and its dietary determinants for graft failure prediction in renal transplant recipients (RTRs). Methods. We included 448 RTRs who participated in the TransplantLines Cohort Study. Cox proportional-hazards regression analyses were performed to study the association of plasma TMAO with graft failure. Net Benefit, which is a decision analysis method, was performed to evaluate the clinical utility of TMAO and dietary information in the prediction of graft failure. Results. Among RTRs (age 52.7 ± 13.1 years; 53% males), the baseline median TMAO was 5.6 (3.0–10.2) µmol/L. In multivariable regression analysis, the most important dietary determinants of TMAO were egg intake (Std. β = 0.09 [95%CI, 0.01; 0.18]; <i>p</i> = 0.03), fiber intake (Std. β = −0.14 [95%CI, −0.22, −0.05]; <i>p</i> = 0.002), and fish and seafood intake (Std. β = 0.12 [95%CI, 0.03,0.21]; <i>p</i> = 0.01). After a median follow-up of 5.3 (4.5–6.0) years, graft failure was observed in 58 subjects. TMAO was associated with an increased risk of graft failure, independent of age, sex, the body mass index (BMI), blood pressure, lipids, albuminuria, and the Estimated Glomerular Filtration Rate (eGFR) (Hazard Ratio per 1-SD increase of TMAO, 1.62 (95% confidence interval (CI): 1.22; 2.14, <i>p</i> < 0.001)). A TMAO and dietary enhanced prediction model offered approximately double the Net Benefit compared to a previously reported, validated prediction model for future graft failure, allowing the detection of 21 RTRs per 100 RTRs tested, with no false positives versus 10 RTRs, respectively. Conclusions. A predictive model for graft failure, enriched with TMAO and its dietary determinants, yielded a higher Net Benefit compared with an already validated model. This study suggests that TMAO and its dietary determinants are associated with an increased risk of graft failure and that it is clinically meaningful.https://www.mdpi.com/2072-6643/13/1/262trimethylamine-<i>N</i>-oxide (TMAO)kidney transplantationdietnet benefit |
| spellingShingle | Jose L. Flores-Guerrero Maryse C. J. Osté Paula B. Baraldi Margery A. Connelly Erwin Garcia Gerjan Navis Stephan J. L. Bakker Robin P. F. Dullaart Association of Circulating Trimethylamine <i>N</i>-Oxide and Its Dietary Determinants with the Risk of Kidney Graft Failure: Results of the TransplantLines Cohort Study Nutrients trimethylamine-<i>N</i>-oxide (TMAO) kidney transplantation diet net benefit |
| title | Association of Circulating Trimethylamine <i>N</i>-Oxide and Its Dietary Determinants with the Risk of Kidney Graft Failure: Results of the TransplantLines Cohort Study |
| title_full | Association of Circulating Trimethylamine <i>N</i>-Oxide and Its Dietary Determinants with the Risk of Kidney Graft Failure: Results of the TransplantLines Cohort Study |
| title_fullStr | Association of Circulating Trimethylamine <i>N</i>-Oxide and Its Dietary Determinants with the Risk of Kidney Graft Failure: Results of the TransplantLines Cohort Study |
| title_full_unstemmed | Association of Circulating Trimethylamine <i>N</i>-Oxide and Its Dietary Determinants with the Risk of Kidney Graft Failure: Results of the TransplantLines Cohort Study |
| title_short | Association of Circulating Trimethylamine <i>N</i>-Oxide and Its Dietary Determinants with the Risk of Kidney Graft Failure: Results of the TransplantLines Cohort Study |
| title_sort | association of circulating trimethylamine i n i oxide and its dietary determinants with the risk of kidney graft failure results of the transplantlines cohort study |
| topic | trimethylamine-<i>N</i>-oxide (TMAO) kidney transplantation diet net benefit |
| url | https://www.mdpi.com/2072-6643/13/1/262 |
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