Risk of end-stage renal disease following live kidney donation.
Risk of end-stage renal disease following live kidney donation.
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DOI：
10.1001/jama.2013.285141
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发表时间：
2014-02-12
影响因子：
120.7
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
--
作者：
Muzaale, Abimereki D.;Massie, Allan B.;Wang, Mei-Cheng;Montgomery, Robert A.;McBride, Maureen A.;Wainright, Jennifer L.;Segev, Dorry L.
已将肾脏捐献者的终末期肾病（ESRD）风险与一般人群面临的风险进行了比较，但一般人群代表了未经筛选的高风险对照人群。与类似筛选的健康非供体进行比较将更正确地估计肾脏捐献的后遗症。比较肾脏捐献者与肾脏疾病风险同样低且无活体捐献禁忌症的健康非捐献者队列的ESRD风险，并按患者人口统计学对这些比较进行分层。1994年4月至2011年11月期间美国96217名肾脏捐献者的队列和第三次全国健康和营养检查调查的20024名参与者的队列（NHANES III）与医疗保险和医疗补助服务中心的数据相关联，以确定ESRD的发展，ESRD的定义是开始维持透析，列入等候名单，或接受活体或已故捐赠者肾脏移植，以先确定者为准。最长随访时间为15.0年;肾脏供体的中位随访时间为7.6年（四分位距[IQR]，3.9-11.5年），匹配的健康非供体为15.0年（IQR，13.7-15.0年）。ESRD的累积发病率和终生风险。在活体捐献者中，中位随访时间为7.6年（最长15.0年），99例患者在捐献后平均（SD）8.6（3.6）年内发生ESRD。在匹配的健康非供者中，中位随访时间为15.0年（最长15.0年），从9364例匹配的健康非供者中的17例ESRD事件中抽取，36例非供者在10.7（3.2）年内发生ESRD。在肾脏捐献者中，捐献后15年ESRD的估计风险为30.8/10000（95%CI，24.3-38.5），在其匹配的健康非捐献者中为3.9/10000（95%CI，0.8-8.9）（P <0.001）。这种差异在黑人和白色个体中均观察到，估计每10000名黑人供体的风险为74.7（95% CI，47.8-105.8）vs 23.9/10000名黑人非供体（95%CI，1.6-62.4; P < .001），估计风险为每10000名白色供体22.7人（95%CI，15.6-30.1），而非白色供体为0.0人（P < .001）。终末期肾病的估计终生风险为90/10000供体，326/10000未筛查的非供体（一般人群），14/10000健康非供体。与匹配的健康非供肾者相比，供肾者ESRD的风险在中位数7.6年内增加;然而，绝对风险增加的幅度很小。这些发现可能有助于与考虑活体肾脏捐赠的人进行讨论。
Risk of end-stage renal disease (ESRD) in kidney donors has been compared with risk faced by the general population, but the general population represents an unscreened, high-risk comparator. A comparison to similarly screened healthy nondonors would more properly estimate the sequelae of kidney donation. To compare the risk of ESRD in kidney donors with that of a healthy cohort of nondonors who are at equally low risk of renal disease and free of contraindications to live donation and to stratify these comparisons by patient demographics. A cohort of 96 217 kidney donors in the United States between April 1994 and November 2011 and a cohort of 20 024 participants of the Third National Health and Nutrition Examination Survey (NHANES III) were linked to Centers for Medicare & Medicaid Services data to ascertain development of ESRD, which was defined as the initiation of maintenance dialysis, placement on the waiting list, or receipt of a living or deceased donor kidney transplant, whichever was identified first. Maximum follow-up was 15.0 years; median follow-up was 7.6 years (interquartile range [IQR], 3.9-11.5 years) for kidney donors and 15.0 years (IQR, 13.7-15.0 years) for matched healthy nondonors. Cumulative incidence and lifetime risk of ESRD. Among live donors, with median follow-up of 7.6 years (maximum, 15.0), ESRD developed in 99 individuals in a mean (SD) of 8.6 (3.6) years after donation. Among matched healthy nondonors, with median follow-up of 15.0 years (maximum, 15.0), ESRD developed in 36 nondonors in 10.7 (3.2) years, drawn from 17 ESRD events in the unmatched healthy nondonor pool of 9364. Estimated risk of ESRD at 15 years after donation was 30.8 per 10 000 (95% CI, 24.3-38.5) in kidney donors and 3.9 per 10 000 (95% CI, 0.8-8.9) in their matched healthy nondonor counterparts (P < .001). This difference was observed in both black and white individuals, with an estimated risk of 74.7 per 10 000 black donors (95% CI, 47.8-105.8) vs 23.9 per 10 000 black nondonors (95% CI, 1.6-62.4; P < .001) and an estimated risk of 22.7 per 10 000 white donors (95% CI, 15.6-30.1) vs 0.0 white nondonors (P < .001). Estimated lifetime risk of ESRD was 90 per 10 000 donors, 326 per 10 000 unscreened nondonors (general population), and 14 per 10 000 healthy nondonors. Compared with matched healthy nondonors, kidney donors had an increased risk of ESRD over a median of 7.6 years; however, the magnitude of the absolute risk increase was small. These findings may help inform discussions with persons considering live kidney donation.
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DOI：
10.2215/cjn.04160511
发表时间：
2011-12-01
影响因子：
9.8
作者：
Berger, Jonathan C.;Muzaale, Abimereki D.;Segev, Dorry L.
通讯作者：
Segev, Dorry L.
DOI：
10.1056/nejmoa0804883
发表时间：
2009-01-29
期刊：
The New England journal of medicine
影响因子：
--
作者：
Ibrahim HN;Foley R;Tan L;Rogers T;Bailey RF;Guo H;Gross CR;Matas AJ
通讯作者：
Matas AJ
影响因子：
158.5
作者：
Lentine, Krista L.;Schnitzler, Mark A.;Brennan, Daniel C.
通讯作者：
Brennan, Daniel C.
影响因子：
19.6
作者：
Garg, A. X.;Muirhead, N.;Boudville, N.
通讯作者：
Boudville, N.
影响因子：
8.8
作者：
Cherikh, W. S.;Young, C. J.;Fan, P. -Y.
通讯作者：
Fan, P. -Y.