Early Hypertension and Diabetes After Living Kidney Donation: A National Cohort Study
Early Hypertension and Diabetes After Living Kidney Donation: A National Cohort Study
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DOI：
10.1097/tp.0000000000002411
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发表时间：
2019-06-01
期刊：
影响因子：
6.2
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
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作者：
Holscher, Courtenay M.;Bae, Sunjae;Segev, Dorry L.
背景活体肾脏捐献者患终末期肾脏疾病的风险增加，高血压和糖尿病是主要原因。在这项研究中，我们试图更好地了解这些疾病发生的时间轴，重点是捐赠后早期。方法.我们研究了2008年至2014年期间美国移植受体科学登记处的41260名活体肾脏供体，并对高血压和糖尿病的发病率和风险因素进行了建模。结果在献血后6个月、1年和2年，每10000名献血者中分别有74、162和310例高血压病例。年龄较大的捐赠者（每10年，校正的发生率比[aIRR]，1.40; 95%置信区间[CI]，1.29-1.51），男性（aIRR，1.31; 95% CI，1.14-1.50），体重指数较高（每5个单位，aIRR，1.29; 95% CI，1.17-1.43），并与其接受者相关（一级亲属：aIRR，1.28; 95% CI，1.08-1.52;配偶：aIRR，1.34; 95% CI，1.08-1.66）更有可能发生高血压，而西班牙裔/拉丁裔供体发生高血压的可能性较小，（aIRR，0.71; 95% CI，0.55-0.93）。在6个月、1年和2年时，每10000名供体中有2例、6例和15例糖尿病病例。年龄较大（每10岁：aIRR，1.42; 95% CI，1.11-1.82）、体重指数较高（每5个单位：aIRR，1.52; 95% CI，1.04-2.21）和西班牙裔/拉丁裔（aIRR，2.45; 95% CI，1.14-5.26）的供体更有可能发生糖尿病。结论.在这项全国性的研究中，新发糖尿病是罕见的，但3%的捐赠者在肾切除术后2年内发展为高血压。这些发现再次证实了肾衰竭的疾病途径因供体表型而异，并估计了最有可能发生后期肾衰竭的人群。
Background. Living kidney donors have an increased risk of end-stage renal disease, with hypertension and diabetes as the predominant causes. In this study, we sought to better understand the timeline when these diseases occur, focusing on the early postdonation period. Methods. We studied 41 260 living kidney donors in the United States between 2008 and 2014 from the Scientific Registry of Transplant Recipients and modeled incidence rates and risk factors for hypertension and diabetes. Results. At 6 months, 1 year, and 2 years postdonation, there were 74, 162, and 310 cases, respectively, of hypertension per 10 000 donors. Donors who were older (per 10 y, adjusted incidence rate ratio [aIRR], 1.40; 95% confidence interval [CI], 1.29-1.51), male (aIRR, 1.31; 95% CI, 1.14-1.50), had higher body mass index (per 5 units, aIRR, 1.29; 95% CI, 1.17-1.43), and were related to their recipient (first-degree relative: aIRR, 1.28; 95% CI, 1.08-1.52; spouse: aIRR, 1.34; 95% CI, 1.08-1.66) were more likely to develop hypertension, whereas donors who were Hispanic/Latino were less likely (aIRR, 0.71; 95% CI, 0.55-0.93). At 6 months, 1 year, and 2 years, there were 2, 6, and 15 cases of diabetes per 10 000 donors. Donors who were older (per 10 y: aIRR, 1.42; 95% CI, 1.11-1.82), had higher body mass index (per 5 units: aIRR, 1.52; 95% CI, 1.04-2.21), and were Hispanic/Latino (aIRR, 2.45; 95% CI, 1.14-5.26) were more likely to develop diabetes. Conclusions. In this national study, new-onset diabetes was rare, but 3% of donors developed hypertension within 2 years of nephrectomy. These findings reaffirm that disease pathways for kidney failure differ by donor phenotype and estimate the population most at-risk for later kidney failure.