Association of Early Postdonation Renal Function With Subsequent Risk of End-stage Renal Disease in Living Kidney Donors
Association of Early Postdonation Renal Function With Subsequent Risk of End-stage Renal Disease in Living Kidney Donors
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DOI：
10.1001/jamasurg.2019.5472
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发表时间：
2020-03-01
期刊：
影响因子：
16.9
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
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作者：
Massie, Allan B.;Holscher, Courtenay M.;Segev, Dorry L.
重要性活体肾脏捐献与终末期肾病（ESRD）的长期风险增加有关。早期终末期肾病风险的捐赠后标志物可以改善肾脏捐赠者的捐赠后风险评估和咨询，并允许对风险增加的捐赠者进行早期干预。目的确定肾脏捐赠者捐赠后前6个月的肾功能与随后的终末期肾病风险之间的关系。这项对前瞻性国家队列的二次分析使用了10月26日至2010年10月30日期间美国所有活体肾脏捐献者的基于人群的登记，1999年和2018年1月1日，随访至2018年12月31日。在日期范围内捐献并在6个月时测量血清肌酐的所有肾脏供体（+/-3个月）。暴露肾功能，通过捐献后6个月的估计肾小球滤过率（eGFR 6）测量。通过与医疗保险和医疗补助服务中心数据的联系确定。结果共纳入71468例活体肾脏供体（在此期间共有109065例供体）。他们的中位（四分位距）eGFR 6为63（54-74）mL/min/1.73 m（2）。献血后15年ESRD的累积发病率范围为11.7/10000例eGFR 6值大于70 mL/min/1.73 m（2）的供体至33.1/10000例eGFR 6值小于或等于50 mL/min/1.73 m（2）的供体。eGFR 6每降低10 mL/min/1.73 m2，ESRD风险增加28%（校正风险比，1.28 [95% CI，1.06-1.54]; P = .009）。献血前eGFR与ESRD之间的相关性不显著，且完全由eGFR 6介导（校正风险比，1.00 [95% CI，0.86-1.17]; P = 0.97）。根据Akaike信息标准，献血后eGFR值是比献血后eGFR下降或eGFR 6与献血前eGFR比值更好的ESRD标志物（其中数值越低表示模型拟合越好; eGFR 6，1495.61;献血前eGFR -eGFR 6，1503.58;结论和相关性在这项研究中，即使在调整了捐献前的特征之后，在活体肾脏捐献者中，eGFR 6与随后的ESRD风险存在独立关联。研究结果支持活体肾脏捐赠者早期血清肌酐监测的测量，并使用这些数据来帮助识别可能需要更仔细监测和早期干预的捐赠者。
IMPORTANCE Living kidney donation is associated with increased long-term risk of end-stage renal disease (ESRD). An early postdonation marker of ESRD risk could improve postdonation risk assessment and counseling for kidney donors and allow early intervention for donors at increased risk.OBJECTIVE To determine the association between renal function in the first 6 months postdonation and subsequent risk of ESRD in kidney donors.DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of a prospective national cohort uses a population-based registry of all living kidney donors in the United States between October 26, 1999, and January 1, 2018, with follow-up through December 31, 2018. All kidney donors who had donated in the date range and had serum creatinine measured at 6 months (+/- 3 months) postdonation were included.EXPOSURES Renal function as measured by estimated glomerular filtration rate 6 months after donation (eGFR6).MAIN OUTCOMES AND MEASURES End-stage renal disease, ascertained via linkage to Centers for Medicare & Medicaid Services data.RESULTS A total of 71 468 living kidney donors were included (of 109 065 total donors over this period). Their median (interquartile range) eGFR6 was 63 (54-74) mL/min/1.73 m(2). Cumulative incidence of ESRD at 15 years postdonation ranged from 11.7 donors per 10 000 donors with eGFR6 values greater than 70 mL/min/1.73 m(2) to 33.1 donors per 10 000 donors with eGFR6 values of 50 mL/min/1.73 m(2) or less. Adjusting for age, race, sex, body mass index, and biological relationship, every 10 mL/min/1.73 m(2) reduction in eGFR6 was associated with a 28% increased risk of ESRD (adjusted hazard ratio, 1.28 [95% CI, 1.06-1.54]; P = .009). The association between predonation eGFR and ESRD was not significant and was fully mediated by eGFR6 (adjusted hazard ratio, 1.00 [95% CI, 0.86-1.17]; P = .97). The postdonation eGFR value was a better marker of ESRD than eGFR decline after donation or the ratio of eGFR6 to predonation eGFR, as determined by the Akaike information criterion (in which a lower value indicates a better model fit; eGFR6, 1495.61; predonation eGFR - eGFR6, 1503.58; eGFR6 / predonation eGFR, 1502.30).CONCLUSIONS AND RELEVANCE In this study, there was an independent association of eGFR6 with subsequent ESRD risk in living kidney donors, even after adjusting for predonation characteristics. The findings support measurement of early postdonation serum creatinine monitoring in living kidney donors, and the use of these data to help identify donors who might need more careful surveillance and early intervention.