Definition of Chronic Kidney Disease After Uninephrectomy in Living Donors: What Are the Implications?
Definition of Chronic Kidney Disease After Uninephrectomy in Living Donors: What Are the Implications?
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DOI：
10.1097/tp.0b013e3181e64237
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发表时间：
2010-09-15
期刊：
影响因子：
6.2
通讯作者：
Glassock, Richard J.
中科院分区：
文献类型：
--
作者：
Barri, Yousri M.;Parker, Tom, III;Glassock, Richard J.
背景。活体肾移植供者通常在肾切除术后具有良好的肾功能结果，但人们仍然担心肾切除术后肾小球滤过率（GFR）降低可能会产生有害影响。本研究探讨了供体肾切除术对GFR和肾切除术后3期慢性肾病（CKD）发生的短期（3个月）影响。通过使用I-125-iothalamate GFR （iGFR）、肾脏疾病饮食改变估计GFR （eGFR）、Cockcroft-Gault估计肌酐清除率和内源性24小时肌酐清除率来比较肾切除术前和肾切除术后3个月的GFR值，研究了196例活体供者3CKD的患病率（肾脏疾病质量结局倡议[GFR < 60 mL/min/1.73m(2)]）。GFR估计预测iGFR的准确性也进行了研究。捐献前后的平均GFR分别为iGFR 105 +/- 18和68 +/- 13 mL/min/1.73 m(2)；eGFR分别为98 +/- 19和63 +/- 12 mL/min/1.73m(2)；Cockcroft-Gault估计肌酐清除率分别为125 +/- 33和85 +/- 22 mL/min/1.73m2，内源性24小时肌酐清除率分别为133 +/- 38和86 +/- 24 mL/min/1.73m2。通过iGFR和eGFR分别在53例（27%）和73例（38%）供者中发现肾切除术后的3期CKD。3期CKD的患病率随着年龄的增长而增加。GFR估计方程不能准确预测iGFR，特别是肾切除术后。3期CKD常见于活体肾脏捐献后，尤其是老年捐赠者。3期CKD肾后切除术的长期影响尚不清楚，可能与其他情况下的3期CKD的影响不同。eGFR不能很好地预测肾脏供者的真实GFR。
Background. Living kidney transplant donors generally have a favorable renal functional outcome postuninephrectomy, but concern remains that a reduced glomerular filtration rate (GFR) postuninephrectomy might have harmful effects. This study examines the short-term (3 months) effect of donor nephrectomy on GFR and the occurrence of stage 3 chronic kidney disease (CKD) postuninephrectomy.Methods. The prevalence of stage 3CKD(Kidney Disease Quality Outcome Initiative [GFR < 60 mL/min/1.73m(2)]) was examined in 196 living donors by comparing preuninephrectomy and 3-month postuninephrectomy values of GFR using I-125-iothalamate GFR (iGFR), modification of diet in renal disease estimated GFR (eGFR), Cockcroft-Gault estimated creatinine clearance, and endogenous 24-hr creatinine clearance. The accuracy of GFR estimations for predicting iGFR was also studied.Results. The mean GFR before and after donation were iGFR, 105 +/- 18 and 68 +/- 13 mL/min/1.73 m(2); eGFR, 98 +/- 19 and 63 +/- 12 mL/min/1.73m(2); Cockcroft-Gault estimated creatinine clearance, 125 +/- 33 and 85 +/- 22 mL/min/1.73m2, and endogenous 24-hr creatinine clearance, 133 +/- 38 and 86 +/- 24 mL/min/1.73 m2, respectively. Stage 3 CKD was found postuninephrectomy in 53 donors (27%) by iGFR and in 73 donors (38%) by eGFR. The prevalence of stage 3 CKD was greater with older age. GFR estimation equations did not accurately predict iGFR, particularly postuninephrectomy.Conclusions. Stage 3 CKD is commonly observed after living kidney donation, particularly in older donors. The long-term impact of stage 3 CKD postuninephrectomy is poorly understood and may not have the same implications as stage 3 CKD in other conditions. eGFR is a poor predictor of true GFR in kidney donors.