■慢性肾脏病在普通人群中与显著的发病率和死亡率相关,但对肾切除术后活体肾脏供者出现低估计肾小球滤过率(eGFR)和中重度白蛋白尿的发生率和危险因素知之甚少.
■回顾性,基于人群的队列研究。
■艾伯塔省的肾脏捐献者,加拿大。
■2001年5月至2017年12月期间的供体肾切除术。
■两次eGFR测量<45mL/min/1.73m2,或两次从捐赠后1年开始测量中度或重度白蛋白尿,间隔至少90天。
■使用Cox比例风险回归分析评估潜在危险因素与主要结局之间的关联。
■中位随访时间为8.6年(IQR,4.7-12.6年),590个捐献者中有47个(8.0%)出现了持续的低eGFR或中重度白蛋白尿,发生率为9.2/1000人年(95%置信区间,6.6-11.8)。肾切除术后第一年后出现这种结果的中位时间为2.9年(IQR,1.4-8.0年)。在随访的前4年内,5mL/min/1.73m2较低的捐献前eGFR使发生捐献后低eGFR或中重度白蛋白尿的风险增加26%(调整后的HR,1.26;95%CI,1.10-1.44)。此外,如果供者有供前高血压的证据,则供者发生低eGFR或蛋白尿的风险较高(调整后的HR,2.52;95%CI,1.28-4.96)或捐赠后糖尿病(调整后HR,4.72;95%CI,1.54-14.50)。
■我们缺乏可能影响长期肾功能的某些供体特征的数据,比如种族,吸烟史,和移植相关的特征。
■每1000人年发病率为9.2的肾脏供体比例在捐献后会出现低eGFR或蛋白尿。捐赠前eGFR较低的捐赠者,捐献前高血压,捐赠后糖尿病发生这种结果的风险增加。
这项研究的目的是了解捐赠后活体肾脏捐献者患肾脏疾病的风险。我们跟踪了艾伯塔省的590个捐赠者,加拿大近9年。大约8%的供体出现肾功能下降(估计的肾小球滤过率低)或尿液中蛋白质增加(白蛋白尿)。捐赠前肾功能较低的捐赠者,捐献前的高血压,或者捐赠后的糖尿病患者经历这些肾脏结局的可能性更高.这项研究为患者和医疗保健提供者提供了重要的见解,以更好地支持活体肾脏供体的长期肾脏健康。
UNASSIGNED: Chronic kidney disease is associated with significant morbidity and mortality in the general population, but little is known about the incidence and risk factors associated with developing low estimated glomerular filtration rate (eGFR) and moderate-severe albuminuria in living kidney donors following nephrectomy.
UNASSIGNED: Retrospective, population-based cohort study.
UNASSIGNED: Kidney donors in Alberta, Canada.
UNASSIGNED: Donor nephrectomy between May 2001 and December 2017.
UNASSIGNED: Two eGFR measurements <45 mL/min/1.73 m2 or 2 measurements of moderate or severe albuminuria from 1-year postdonation onwards that were at least 90 days apart.
UNASSIGNED: Associations between potential risk factors and the primary outcome were assessed using Cox proportional hazard regression analyses.
UNASSIGNED: Over a median follow-up period of 8.6 years (IQR, 4.7-12.6 years), 47 of 590 donors (8.0%) developed sustained low eGFR or moderate-severe albuminuria with an incidence rate of 9.2 per 1,000 person-years (95% confidence interval, 6.6-11.8). The median time for development of this outcome beyond the first year after nephrectomy was 2.9 years (IQR, 1.4-8.0 years). Within the first 4 years of follow-up, a 5 mL/min/1.73 m2 lower predonation eGFR increased the hazard of developing postdonation low eGFR or moderate-severe albuminuria by 26% (adjusted HR, 1.26; 95% CI, 1.10-1.44). Furthermore, donors were at higher risk of developing low eGFR or albuminuria if they had evidence of predonation hypertension (adjusted HR, 2.52; 95% CI, 1.28-4.96) or postdonation diabetes (adjusted HR, 4.72; 95% CI, 1.54-14.50).
UNASSIGNED: We lacked data on certain donor characteristics that may affect long-term kidney function, such as race, smoking history, and transplant-related characteristics.
UNASSIGNED: A proportion of kidney donors at an incidence rate of 9.2 per 1,000 person-years will develop low eGFR or albuminuria after donation. Donors with lower predonation eGFR, predonation hypertension, and postdonation diabetes are at increased risk of developing this outcome.
The purpose of this study was to understand the risk of developing kidney disease in living kidney donors after donation. We followed 590 donors in Alberta, Canada for almost 9 years. Approximately 8% of donors developed reduced kidney function (low estimated glomerular filtration rate) or increased protein in the urine (albuminuria). Donors with lower kidney function before donation, hypertension before donation, or diabetes after donation had a higher likelihood of experiencing these kidney outcomes. This research provides important insights to patients and health care providers to better support the long-term kidney health of living kidney donors.