■肾小球滤过率(GFR)在2年内下降≥30%可以替代常规的“血清肌酐倍增”,以预测患有天然肾脏的患者的终末期肾脏疾病。虽然移植患者的慢性肾病轨迹难以预测,最近的数据表明,对于长期移植结局,类似的GFR下降可能是可接受的替代因素.我们寻求(i)确认肾移植受者早期GFR下降的预后价值,以及(ii)确定使用菊糖直接测量GFR是否可以改善该替代药物的性能。
■我们回顾性分析了1989年至2000年在我们中心移植的所有受体,移植后1年和5年的菊粉测量和慢性肾病流行病学合作(CKD-EPI)估计的GFR,并评估GFR变化的性能[受试者工作特征曲线下面积(ROCAUC)和子分布风险比(sdHR)以及竞争风险模型]以预测移植物失败和全因死亡率。
■在417名肾移植受者中,116例患者在移植后16年失去了移植物,77例死亡。虽然与移植物失败显着相关[sdHR=2.37(95%置信区间1.47-3.83)],CKD-EPI-GFR下降≥30%未能适当预测长期移植物存活(C统计量为0.63)。菊粉-GFR和CKD-EPI-GFR检测相似GFR变化的一致性仅为53%。菊粉-GFR变化为,然而,不是更好的预测因子(C统计量为0.59)。观察到死亡率的结果相当。
■我们的数据表明,早期GFR下降是长期移植结果的不良替代因素,即使通过参考方法直接测量GFR的变化。
UNASSIGNED: Glomerular filtration rate (GFR) decline ≥30% over 2 years can substitute for the conventional \'doubling of serum creatinine\' to predict end-stage renal disease in patients with native kidneys. While chronic kidney disease trajectory is less predictable in transplanted patients, recent data have suggested that similar GFR decline might be an acceptable surrogate for long-term transplant outcome. We sought (i) to confirm the prognostic value of an early GFR decline in kidney transplant recipients and (ii) to determine whether using direct measurement of GFR with inulin improves the performance of this surrogate.
UNASSIGNED: We retrospectively analysed all recipients transplanted between 1989 and 2000 in our centre, with inulin-measured and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-estimated GFR at 1 and 5 years post-transplant, and evaluated the performance [time-dependent area under the receiver operating characteristic curve (ROC AUC) and subdistribution hazard ratio (sdHR) with competing risk model] of GFR change to predict graft failure and all-cause mortality.
UNASSIGNED: Out of 417 kidney transplant recipients, 116 patients had lost their graft and 77 had died 16 years after transplantation. While being significantly associated with graft failure [sdHR = 2.37 (95% confidence interval 1.47-3.83)], CKD-EPI-GFR decline ≥30% failed to appropriately predict long-term graft survival (C-statistics of 0.63). Concordance between inulin-GFR and CKD-EPI-GFR to detect similar GFR change was only 53%. Inulin-GFR change was, however, not a better predictor (C-statistics of 0.59). Comparable results were observed for mortality.
UNASSIGNED: Our data suggest that early GFR decline is a poor surrogate for long-term transplant outcome, even when change in GFR is directly measured by a reference method.