{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:58:42Z","timestamp":1790269122543,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,4,23]],"date-time":"2015-04-23T00:00:00Z","timestamp":1429747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The effect of a low protein intake on survival in renal transplant recipients (<jats:styled-content style=\"fixed-case\">RTR<\/jats:styled-content>) is unknown. A low protein intake may increase risks of malnutrition, low muscle mass, and death. We aimed to study associations of protein intake with mortality and graft failure and to identify potential intermediate factors. Protein intake was estimated from 24\u2010h urinary urea excretion (24\u2010h UUE). Graft failure was defined as return to dialysis or retransplantation. We used <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ox regression analyses to analyze associations with outcome and potential intermediate factors in the causal path. In 604 <jats:styled-content style=\"fixed-case\">RTR<\/jats:styled-content>, mean\u00a0\u00b1\u00a0SD 24\u2010h <jats:styled-content style=\"fixed-case\">UUE<\/jats:styled-content> was 380\u00a0\u00b1\u00a0114\u00a0mmol\/24\u2010h. During median follow\u2010up for 7.0\u00a0yr (interquartile range: 6.2\u20137.5\u00a0yr), 133 <jats:styled-content style=\"fixed-case\">RTR<\/jats:styled-content> died and 53 developed graft failure. In univariate analyses, 24\u2010h <jats:styled-content style=\"fixed-case\">UUE<\/jats:styled-content> was associated with lower risk of mortality (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> [95% CI]\u00a0=\u00a00.80 [0.69\u20130.94]) and graft failure (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> [95% CI]\u00a0=\u00a00.72 [0.56\u20130.92]). These associations were independent of potential confounders. In causal path analyses, the association of 24\u2010h <jats:styled-content style=\"fixed-case\">UUE<\/jats:styled-content> with mortality disappeared after adjustment for muscle mass. Low protein intake is associated with increased risk of mortality and graft failure in <jats:styled-content style=\"fixed-case\">RTR<\/jats:styled-content>. Causal path analyses reveal that the association with mortality is explained by low muscle mass. These findings suggest that protein intake restriction should not be advised to <jats:styled-content style=\"fixed-case\">RTR<\/jats:styled-content>.<\/jats:p>","DOI":"10.1111\/ctr.12536","type":"journal-article","created":{"date-parts":[[2015,3,4]],"date-time":"2015-03-04T15:02:18Z","timestamp":1425481338000},"page":"447-457","source":"Crossref","is-referenced-by-count":31,"title":["Causal path analyses of the association of protein intake with risk of mortality and graft failure in renal transplant recipients"],"prefix":"10.1111","volume":"29","author":[{"given":"M. Yusof","family":"Said","sequence":"first","affiliation":[{"name":"Division of Nephrology Department of Internal Medicine University Medical Center Groningen and University of Groningen Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petronella E.","family":"Deetman","sequence":"additional","affiliation":[{"name":"Division of Nephrology Department of Internal Medicine University Medical Center Groningen and University of Groningen Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiko P. 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