Fracture Risk Among Living Kidney Donors 25 Years After Donation.
Fracture Risk Among Living Kidney Donors 25 Years After Donation.
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DOI：
10.1001/jamanetworkopen.2023.53005
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发表时间：
2024-01-02
影响因子：
13.8
通讯作者：
Kumar R
中科院分区：
文献类型：
--
作者：
Maradit Kremers H;Grossardt BR;Miller AR;Kasiske BL;Matas AJ;Khosla S;Kremers WK;Amer H;Kumar R
活体肾捐献者整体骨折和特定部位骨折的长期风险有多大？在这项包含 2132 名活体肾脏捐献者和 2014 年对照者的调查研究中，捐献者的总体骨折率显着低于对照者。然而，捐赠者中的椎骨骨折明显多于对照组。这项研究表明，虽然捐献者的总体骨折率较低，但肾脏质量的减少和长期的甲状旁腺功能亢进可能会使活体肾脏捐献者容易出现小梁骨丢失和椎骨骨折。由于肾脏质量减少、血清 1,25-二羟基维生素 D 浓度降低以及血清甲状旁腺激素继发性增加，活体肾捐赠者骨折的风险可能会增加。比较活体肾脏捐献者的整体和特定部位骨折风险与严格匹配的对照组，这些对照来自本来有资格捐献肾脏但没有捐献的普通人群。这项调查研究于2021年12月1日至2023年7月31日期间进行。来自明尼苏达州3个大型移植中心的总共5065名活体肾脏捐献者被邀请完成一项关于他们的骨骼健康和骨折史的调查，并从罗切斯特流行病学项目中确定了16-156名没有可能妨碍肾脏捐献的合并症史的基于人群的非捐献者对照，并完成了相同的调查。共有 2132 名活体肾脏捐献者和 2014 名非捐献者对照者参与了此次调查。统计分析于 2023 年 5 月至 8 月进行。活体肾脏捐赠。使用标准化发生率（SIR）比较活体肾捐献者和对照者之间的总体骨折率和特定部位骨折率。截至调查时，2132 名活体肾脏捐献者的平均 (SD) 年龄为 67.1 (8.9) 岁，其中包括 1245 名女性 (58.4%)，2014 年对照组的平均 (SD) 年龄为 68.6 (7.9) 岁，包括 1140 名女性 (56.6%)。捐赠者或索引日期与调查日期之间的平均 (SD) 时间为 24.2 (10.4) 年，对照组为 27.6 (10.7) 年。活体肾捐献者的总体骨折率显着低于对照组（SIR，0.89；95% CI，0.81-0.97）。然而，活体肾捐献者中的椎骨骨折明显多于对照组（SIR，1.42；95% CI，1.05-1.83）。这项调查研究发现，平均随访 25 年后，与对照组相比，活体肾脏捐赠者的总体骨折率有所降低，但椎骨骨折的比例较高。使用维生素 D3 等膳食补充剂治疗过度椎体骨折可能会减少椎体骨折的数量和患者的发病率。这项调查研究将活体肾脏捐献者的总体和特定部位骨折风险与来自普通人群的严格匹配的对照进行了比较，这些对照组本来有资格捐献肾脏，但没有这样做。
What is the long-term risk of overall and site-specific fractures among living kidney donors? In this survey study that included 2132 living kidney donors and 2014 controls, the overall rate of fractures was significantly lower among donors than controls. However, there were significantly more vertebral fractures among donors than controls. This study suggests that, although the overall fracture rate among donors was low, reductions in kidney mass and prolonged hyperparathyroidism may predispose living kidney donors to trabecular bone loss and vertebral fractures. Living kidney donors may have an increased risk of fractures due to reductions in kidney mass, lower concentrations of serum 1,25-dihydroxyvitamin D, and secondary increases in serum parathyroid hormone. To compare the overall and site-specific risk of fractures among living kidney donors with strictly matched controls from the general population who would have been eligible to donate a kidney but did not do so. This survey study was conducted between December 1, 2021, and July 31, 2023. A total of 5065 living kidney donors from 3 large transplant centers in Minnesota were invited to complete a survey about their bone health and history of fractures, and 16 156 population-based nondonor controls without a history of comorbidities that would have precluded kidney donation were identified from the Rochester Epidemiology Project and completed the same survey. A total of 2132 living kidney donors and 2014 nondonor controls responded to the survey. Statistical analyses were performed from May to August 2023. Living kidney donation. The rates of overall and site-specific fractures were compared between living kidney donors and controls using standardized incidence ratios (SIRs). At the time of survey, the 2132 living kidney donors had a mean (SD) age of 67.1 (8.9) years and included 1245 women (58.4%), and the 2014 controls had a mean (SD) age of 68.6 (7.9) years and included 1140 women (56.6%). The mean (SD) time between donation or index date and survey date was 24.2 (10.4) years for donors and 27.6 (10.7) years for controls. The overall rate of fractures among living kidney donors was significantly lower than among controls (SIR, 0.89; 95% CI, 0.81-0.97). However, there were significantly more vertebral fractures among living kidney donors than among controls (SIR, 1.42; 95% CI, 1.05-1.83). This survey study found a reduced rate of overall fractures but an excess of vertebral fractures among living kidney donors compared with controls after a mean follow-up of 25 years. Treatment of excess vertebral fractures with dietary supplements such as vitamin D3 may reduce the numbers of vertebral fractures and patient morbidity. This survey study compares the overall and site-specific risk of fractures among living kidney donors with strictly matched controls from the general population who would have been eligible to donate a kidney but did not do so.
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DOI：
10.1038/ki.2009.188
发表时间：
2009-08-01
期刊：
Kidney international. Supplement
影响因子：
--
作者：
通讯作者：
--
影响因子：
4.2
作者：
Huan, Yonghong;Kapoor, Shiv;Townsend, Raymond R.
通讯作者：
Townsend, Raymond R.
影响因子：
13.2
作者：
Coco, M;Rush, H
通讯作者：
Rush, H
影响因子：
13.2
作者：
Danese, MD;Kim, J;Chertow, GM
通讯作者：
Chertow, GM
影响因子：
158.5
作者：
Grams, Morgan E.;Sang, Yingying;Garg, Amit X.
通讯作者：
Garg, Amit X.