背景:晚期慢性肾病与肌肉萎缩有关,但肾移植后肾小球滤过率(GFR)恢复与肌肉质量的相关性尚不清楚.
方法:我们利用移植后3个月和在我们机构的稍后时间点同时测量GFR(使用碘海醇血浆清除率;ioGFR)和肌酐排泄率(肌肉质量的替代标记;CER)来研究同种异体移植功能之间的相互作用,肌肉质量,和肾移植受者的结果。
结果:在2005年6月至2019年10月之间,有1319名连续肾移植受者(平均年龄50.4±14.6;38.7%为女性)在肾移植后3个月在我们机构接受了GFR测量。CER(CER3)和ioGFR(ioGFR3)分别为7.7±2.6μmol/min和53±17.1mL/min/1.73m2,分别。多变量分析确定了女性性别,较大的捐赠者和接受者年龄,降低体重指数,冠状动脉疾病,透析史,蛋白尿,和降低的ioGFR3作为低CER3的独立预测因子(ioGFR3:β系数0.19[95%置信区间0.14至0.24])。在中位随访9.5个月后,共有1165名患者进行了随后的CER测量。其中,373(32%)经历了CER>10%的增长,而222(19%)的CER下降超过10%。校正CER3和其他混杂因素的多变量分析确定ioGFR3是随访时CER的独立预测因子(β系数0.11[95%置信区间0.07至0.16])。在多变量Cox分析中,3个月时或随访时的CER降低始终与死亡率相关(3个月时的风险比[95%置信区间]:0.82[0.74~0.91];随访时:0.79[0.69~0.99]),但与移植物丢失无关.
结论:肾小球滤过率恢复是肾移植后肌肉质量变化的一个决定因素。针对肌肉质量增加的早期干预措施可能对肾移植受者有益。
Advanced chronic kidney disease is associated with muscle wasting, but how glomerular filtration rate (GFR) recovery after kidney transplantation is associated with muscle mass is unknown.
We took advantage of the simultaneous measurement of GFR (using iohexol plasma clearance; ioGFR) and creatinine excretion rate (a surrogate marker of muscle mass; CER) performed 3 months after transplantation and at a later time point at our institution to investigate the interplay between allograft function, muscle mass, and outcome in kidney transplant recipients.
Between June 2005 and October 2019, 1319 successive kidney transplant recipients (mean age 50.4 ± 14.6; 38.7% female) underwent GFR measurement at our institution 3 months after kidney transplantation. CER (CER3 ) and ioGFR (ioGFR3 ) were 7.7 ± 2.6 μmol/min and 53 ± 17.1 mL/min/1.73 m2 , respectively. Multivariable analysis identified female gender, older donor and recipient age, reduced body mass index, coronary disease, dialysis history, proteinuria, and reduced ioGFR3 as independent predictors of low CER3 (ioGFR3 : β coefficient 0.19 [95% confidence interval 0.14 to 0.24]). A total of 1165 patients had a subsequent CER measurement after a median follow-up of 9.5 months. Of them, 373 (32%) experienced an increase in CER > 10%, while 222 (19%) showed a CER decrease of more than 10%. Multivariable analysis adjusted for CER3 and other confounders identified ioGFR3 as an independent predictor of CER at follow-up (β coefficient 0.11 [95% confidence interval 0.07 to 0.16]). In multivariable Cox analysis, reduced CER at 3 months or at follow-up were consistently associated with mortality (hazard ratio [95% confidence interval] at 3 months: 0.82 [0.74 to 0.91]; at follow-up: 0.79 [0.69 to 0.99]) but not with graft loss.
Glomerular filtration rate recovery is a determinant of muscle mass variation after kidney transplantation. Early interventions targeting muscle mass gain may be beneficial for kidney transplant recipients.