Development and Validation of a Hypertension Risk Calculator for Living Kidney Donors.
Development and Validation of a Hypertension Risk Calculator for Living Kidney Donors.
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活体肾脏捐赠者高血压风险计算器的开发和验证。
DOI：
10.1097/tp.0000000000004505
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发表时间：
2023
期刊：
影响因子：
6.2
通讯作者：
Matas,ArthurJ
中科院分区：
文献类型：
--
作者：
Helgeson,ErikaS;Vempati,Shruti;Palzer,EliseF;Mjoen,Geir;Haugen,AndersJ;Matas,ArthurJ
背景：理想情况下，当决定是否捐献时，肾脏捐献者候选人应该了解他们的长期风险。使用单中心数据（N= 4055;中位数[四分位数]随访：18 [9-28]年），我们开发了一个计算器，为献血后高血压和验证它使用长期数据从外部单中心队列（N= 1189，中位数[四分位数]随访：9 [5-17]年）。两种建模方法进行了评价：考克斯比例风险和随机生存森林模型。交叉验证预测误差和Harrell的一致性指数被用来比较模型开发的准确性。在验证队列中使用一致性指数和净重新分类improvement.Results.In开发队列，34%的高血压患者在捐赠后16（8-24）年的中位数（四分位数）;在验证队列中，29%的患者在捐赠后17（10-22）年报告高血压。最准确的模型是考克斯比例风险模型，包括年龄、性别、种族、估计的肾小球滤过率、收缩压和舒张压、体重指数、血糖、吸烟史、高血压家族史、与受体的关系和高脂血症（一致性指数，结论：建立并验证了一个献血后高血压计算器;它为肾脏捐献者候选人、他们的家人和护理团队提供了一个可以纳入知情同意过程的高血压风险的长期预测。
Background.Ideally, when deciding whether to donate, kidney donor candidates would understand their long-term risks. Using single-center data (N= 4055; median [quartiles] follow-up: 18 [9–28] y), we developed a calculator for postdonation hypertension and validated it using long-term data from an external single-center cohort (N= 1189, median [quartiles] follow-up: 9 [5–17] y).Methods.Risk factors considered were routinely obtained at evaluation from donor candidates. Two modeling approaches were evaluated: Cox proportional hazards and random survival forest models. Cross-validation prediction error and Harrell’s concordance-index were used to compare accuracy for model development. Top-performing models were assessed in the validation cohort using the concordance-index and net reclassification improvement.Results.In the development cohort, 34% reported hypertension at a median (quartiles) of 16 (8–24) y postdonation; and in the validation cohort, 29% reported hypertension after 17 (10–22) y postdonation. The most accurate model was a Cox proportional hazards model with age, sex, race, estimated glomerular filtration rate, systolic and diastolic blood pressure, body mass index, glucose, smoking history, family history of hypertension, relationship with recipient, and hyperlipidemia (concordance-index, 0.72 in the development cohort and 0.82 in the validation cohort).Conclusions.A postdonation hypertension calculator was developed and validated; it provides kidney donor candidates, their family, and care team a long-term projection of hypertension risk that can be incorporated into the informed consent process.