Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate
Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate
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DOI：
10.1056/nejmoa1510491
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发表时间：
2016-02-04
影响因子：
158.5
通讯作者：
Garg, Amit X.
中科院分区：
文献类型：
--
作者：
Grams, Morgan E.;Sang, Yingying;Garg, Amit X.
评估作为活体肾脏捐赠者的候选人依赖于对终末期肾病（ESRD）的个体风险因素的筛查。为了支持捐赠者选择的经验方法，我们开发了一种工具，同时结合多种健康特征来估计一个人的可能的长期风险终末期肾病，如果这个人不捐肾。METHODSWe使用的风险协会从荟萃分析7个一般人群队列，校准到人口水平的发病率终末期肾病和死亡率在美国，根据10项人口统计学和健康特征，预测未捐献肾脏的人群中ESRD的估计长期发病率。然后，我们将15年预测与美国52，998名活体肾脏捐献者的观察风险进行了比较。来自7个队列的4，933，314名参与者接受了为期4至16年的中位数随访。对于一个40岁的人，其健康特征与年龄匹配的肾脏捐赠者相似，在没有捐赠的情况下，15年的ESRD风险预测因种族和性别而异;黑人男性的风险为0.24%，黑人女性为0.15%，白色男性为0.06%，白色女性为0.04%。在肾小球滤过率估计值较低、蛋白尿较高、高血压、当前或既往吸烟、糖尿病和肥胖的情况下，风险预测较高。在基于模型的终生预测中，最年轻年龄组的人，特别是年轻黑人，患终末期肾病的风险最高。15年观察到的风险在美国肾脏捐赠者之间捐赠后的3.5至5.3倍，预计在没有donate.CONCLUSIONSMultiple人口统计学和健康特征的风险高，可以一起使用来估计预测的长期风险终末期肾病之间的生活肾脏捐赠者的候选人，并通知肾脏捐赠者的接受标准。
BACKGROUNDEvaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney.METHODSWe used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States.RESULTSA total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation.CONCLUSIONSMultiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors.