Changes in kidney function follow living donor nephrectomy
Changes in kidney function follow living donor nephrectomy
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DOI：
10.1016/j.kint.2020.03.034
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发表时间：
2020-07-01
影响因子：
19.6
通讯作者：
Garg, Amit X.
中科院分区：
文献类型：
--
作者：
Lam, Ngan N.;Lloyd, Anita;Garg, Amit X.
更好地了解活体供肾切除术后的肾功能以及供体特征如何不同，可以为患者选择，咨询和随访提供信息。为了评估这一点，我们在2002-2016年期间对加拿大阿尔伯塔的活体肾脏捐献者进行了一项回顾性匹配队列研究，使用链接的医疗保健管理数据库。我们根据年龄、性别、进入队列的年份、城市居住和进入队列前的估计肾小球滤过率（eGFR）（供体的肾切除日期和非供体的随机分配日期），将604名供体与2，414名来自一般人群的健康非供体进行匹配。主要结局是eGFR随时间的变化率（中位随访7年;最长15年）。队列的中位年龄为43岁，64%为女性，基线（献血前）eGFR为100 mL/min/1.73 m2。总体而言，从6周开始，供体的eGFR每年增加+0.35 mL/min/1.73 m2（95%置信区间为+0.21至+0.48），匹配的健康非供体的eGFR每年显著降低-0.85 mL/min/1.73 m2（-0.94至-0.75）。供体中6周至2年、2至5年和5年以上的eGFR变化分别为+1.06、+0.64和-0.06 mL/min/1.73 m2/年。与非捐献者肾功能稳定的年龄相关性下降相反，由于肾小球超滤，捐献后肾功能平均最初每年增加1 mL/min/1.73 m2，并在捐献后5年开始达到平台。因此，eGFR随时间的平均变化在供体和非供体之间显著不同。
Better understanding of kidney function after living donor nephrectomy and how it differs by donor characteristics can inform patient selection, counselling, and follow-up care. To evaluate this, we conducted a retrospective matched cohort study of living kidney donors in Alberta, Canada between 2002-2016, using linked healthcare administrative databases. We matched 604 donors to 2,414 healthy non-donors from the general population based on age, sex, year of cohort entry, urban residence and the estimated glomerular filtration rate (eGFR) before cohort entry (nephrectomy date for donors and randomly assigned date for non-donors). The primary outcome was the rate of eGFR change over time (median follow-up seven years; maximum 15 years). The median age of the cohort was 43 years, 64% women, and the baseline (pre-donation) eGFR was 100 mL/min/1.73 m2. Overall, from six weeks onwards, the eGFR increased by +0.35 mL/min/1.73 m2per year (95% confidence interval +0.21 to +0.48) in donors and significantly decreased by -0.85 mL/min/1.73 m2per year (-0.94 to -0.75) in the matched healthy non-donors. The change in eGFR between six weeks to two years, two to five years, and over five years among donors was +1.06, +0.64, and -0.06 mL/min/1.73 m2per year, respectively. In contrast to the steady age-related decline in kidney function in non-donors, post-donation kidney function on average initially increased by 1 mL/min/1.73 m2per year attributable to glomerular hyperfiltration, which began to plateau by five years post-donation. Thus, the average change in eGFR over time is significantly different between donors and non-donors.