{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T07:27:42Z","timestamp":1786692462623,"version":"build-2736575974"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007605","name":"Aarhus Universitet","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007605","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pflugers Arch - Eur J Physiol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Functional assessment is essential to quantify kidney graft quality early after kidney transplantation. Kidney transplantation is inherently associated with ischemia\u2013reperfusion-injury, a noxious insult for proximal tubule cells that may not be captured by glomerular function markers. The urine ammonium-pH index (uAPI) is a functional measure of the tubulointerstitial capacity for ammonium excretion. Here, we aimed to investigate the association between the uAPI and graft function in kidney transplant recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this post-hoc observational analysis of the CONTEXT trial (NCT01395719), kidney transplant recipients with available urine samples were divided into an exploration cohort (n\u2009=\u2009112) and a validation cohort (n\u2009=\u200988). The uAPI was assessed at baseline, 90\u00a0min after reperfusion, day 1, 2 and 3 posttransplant. Day 6 kidney graft biopsies were stained for VCAM1 as a marker of tubular injury. Outcomes were delayed graft function, estimated time to 50% reduction in plasma creatinine, and measured GFR on day 5 and 12\u00a0months posttransplant. Results were adjusted for age, sex, plasma creatinine and albuminuria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the exploration cohort, a higher uAPI on day 2 and day 3 was associated with lower VCAM1 expression (p\u2009&lt;\u20090.001 and p\u2009=\u20090.002, respectively), lower risk of delayed graft function, and shorter estimated time to 50% reduction in plasma creatinine (p\u2009&lt;\u20090.001). A higher uAPI on day 3 was associated with higher measured GFR on day 5 (p\u2009&lt;\u20090.001) and at 12\u00a0months (p\u2009&lt;\u20090.001) posttransplant. These findings were confirmed in the validation cohort and robust to adjustments. Associations between day 3 uAPI and long-term graft function were consistent in subgroup analyses, including in patients with vs. without delayed graft function. Inclusion of day 3 uAPI improved prediction of measured GFR\u2009&gt;\u200960 at 12\u00a0months posttransplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A higher uAPI likely informs about better tubulointerstitial function posttransplant and is associated with better early and 12-month kidney graft function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00424-026-03198-5","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T01:09:19Z","timestamp":1784855359000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Early Posttransplant urine ammonium-pH index levels and graft outcomes in kidney transplant recipients"],"prefix":"10.1007","volume":"478","author":[{"given":"Marie B.","family":"Nielsen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoline V.","family":"Krogstrup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mads V.","family":"S\u00f8rensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders M.","family":"Kristensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the CONTEXT Study Group*","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bente","family":"Jespersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Oltean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertrude J.","family":"Nieuwenhuijs-Moeke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J. 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Researchers who would like to inspect the raw data may apply for controlled access, subject to institutional approval. Data inquiries should be directed to the corresponding authors.","order":1,"name":"Ethics","label":"Data sharing statement","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"MVS, JL, HB, and PB are listed as inventors on a patent application filed by Aarhus University describing the prognostic value of urine acid\u2013base measures in chronic kidney disease. MVS, JL, and PB are co-founders and shareholders of Equilibrium Diagnostics.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"68"}}