Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation
Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation
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DOI：
10.1159/000487714
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发表时间：
2018-01-01
影响因子：
4.2
通讯作者：
Taber, David J.
中科院分区：
文献类型：
--
作者：
Pilch, Nicole A.;Rohan, Vinayak;Taber, David J.
背景：已经进行了几项研究来评估肾移植受者长期同种异体移植物功能的替代标志物。这些包括血清肌酐、估计肾小球滤过率 (eGFR)、eGFR 斜率以及最近的 eGFR 变异性。本研究的目的是测量 eGFR 斜率，同时评估该斜率的变异性，以及移植后任何时间发生的高变异性是否预示着大量肾移植受者的长期结果较差。方法：纳入2005年7月1日至2015年7月31日期间移植的成年孤立肾移植受者。主要结局是移植物丢失的时间，定义为恢复慢性透析、再次移植或死亡。次要结局是死亡审查的移植物丢失和急性同种异体移植物排斥。 Cox 回归用于主要和次要结果。使用多变量逻辑回归来确定预测 eGFR 高变异性的基线因素。结果：总共 1,543 名患者纳入分析。 eGFR 变异系数 < 30% 的患者比例为 79.6% (1,229/1,543)，而 20.4% (314/1,543) 患者的 eGFR 变异系数较高 (>= 30%)。 eGFR 变异性较高的患者往往更年轻、非裔美国人和女性。那些具有较高 eGFR 变异性的患者，考虑到混杂因素和其他 eGFR 测量值（峰值和斜率），患者和移植物的总体存活率显着较低。结论：本研究对大型队列中 eGFR 变异性的效用进行了新颖的分析。 eGFR 斜率和 eGFR 变异性的临床应用可能有助于预测长期移植物结果，并促进早期患者讨论以改变同种异体移植物功能的轨迹。 (C) 2018 S. Karger AG，巴塞尔
Background: Several studies have been performed to evaluate surrogate markers of long-term allograft function in renal transplant recipients. These include serum creatinine, estimated glomerular filtration rate (eGFR), slope of eGFR, and more recently eGFR variability. The aim of this study was to measure eGFR slope while assessing the variability of this slope and if high variability occurring at any time post-transplant was predictive of poorer long-term outcomes in a large cohort of kidney transplant recipients. Methods: Adult solitary kidney transplant recipients transplanted between July 1, 2005 and July 31, 2015 were included. The primary outcome was time to graft loss, defined as return to chronic dialysis, retransplant, or death. Secondary outcomes were death-censored graft loss and acute allograft rejection. Cox regression was utilized for primary and secondary outcomes. Multivariate logistic regression was used to determine baseline factors predictive of high eGFR variability. Results: A total of 1,543 patients were included in the analysis. The percentage of patients who experienced an eGFR coefficient of variation of < 30% was 79.6% (1,229/1,543), while 20.4% (314/1,543) patients had high eGFR variability (>= 30%). Patients with high eGFR variability tended to be younger, African-American and female. Those with higher eGFR variability, accounting for confounding and other eGFR measures (peak and slope), had significantly lower overall patient and graft survival. Conclusion: This study provides a novel analysis of the utility of eGFR variability in a large cohort. The clinical use of the slope of eGFR and eGFR variability may aid in predicting long-term graft outcomes and facilitate early patient discussions to change the trajectory of allograft function. (C) 2018 S. Karger AG, Basel