Influence of Residual Metabolic Risk on Renal Graft Function in Kidney Transplant Recipients: A Five-Year Retrospective Cohort Study

Background: Residual metabolic risk (RMR), defined as persistent cardiovascular risk despite achieving treatment goals for traditional risk factors, has emerged as a critical determinant of allograft outcomes in kidney transplantation. Specific patterns of RMR, particularly dyslipidemia despite standard therapy, significantly impact renal graft function independent of immunological factors. Methods: A single-center retrospective cohort study analyzing 131 living donor renal transplant recipients in the University Hospital of Clinics La Paz Bolivia, followed from 2018-2023, with 39 meeting inclusion criterio: age ≥18 years, intermediate-to-very high RMR classification, complete lipid profiles. Primary outcome was estimated glomerular filtration rate (eGFR) decline over the 5-year follow-up period. Statistical analysis employed chi-square and Spearman correlation using SPSS v25. Results: The study cohort (mean age 37.5±7.2 years, 58% male) predominantly exhibited secondary glomerulopathy as primary diagnosis (p=0.068). Patients with intermediate RMR presented with baseline eGFR of 45.59±4.8 ml/min/1.73m2. The significant inverse relationship between RMR severity and allograft function (p=0.026), with greater eGFR decline correlating with progression to very high RMR, eGFR <30 ml/min/1.73m2. Despite lipid-lowering therapy, persistent LDL cholesterol elevations were associated with 25% reduction in eGFR over the study period (RR: 7.3; p=0.017). Conclusion: Elevated residual metabolic risk independently predicts accelerated renal allograft dysfunction in living donor kidney transplant recipients, with a 25% decline in eGFR observed in patients with higher risk profiles. Data suggest that post-transplant metabolic monitoring and targeted management strategies beyond traditional lipid goals may represent an important opportunity to extend allograft longevity.