Race, Relationship and Renal Diagnoses After Living Kidney Donation.
Race, Relationship and Renal Diagnoses After Living Kidney Donation.
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DOI：
10.1097/tp.0000000000000733
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发表时间：
2015-08
期刊：
影响因子：
6.2
通讯作者：
Segev DL
中科院分区：
文献类型：
--
作者：
Lentine KL;Schnitzler MA;Garg AX;Xiao H;Axelrod D;Tuttle-Newhall JE;Brennan DC;Segev DL
根据最近的研究，需要更好地了解非裔美国人和生物学相关的活体肾脏捐赠者的肾脏并发症风险。我们检查了一个数据库，该数据库将美国活体肾脏捐赠者的注册标识符（1987-2007 年）与私人健康保险公司的账单索赔（2000-2007 年索赔）联系起来，以识别按国际疾病分类第九版修订版 (ICD-9) 编码分类的肾脏疾病诊断。使用左和右审查的 Cox 回归来估计捐赠后诊断的累积发生率以及与捐赠者特征的关联（调整后的风险比，aHR）。在 4,650 名 LKD 中，13.1% 是非裔美国人，76.3% 是白人； 76.1%是受赠者的一级亲属。捐献后七年，调整年龄和性别后，与白人捐献者相比，非洲裔美国人捐献者中诊断出肾脏疾病的比例更高：慢性肾病（12.6% vs 5.6%，aHR 2.32，95% CI 1.48–3.62）、蛋白尿（5.7% vs 2.6%，aHR 2.27、95% CI 1.32–3.89）、肾病综合征（1.3% vs 0.1%，aHR 15.7，95% CI 2.97–83.0），以及任何肾脏诊断（14.9% vs 9.0%，aHR 1.71，95% CI 1.23–2.41）。虽然与受体的一级生物学关系与肾脏风险无关，但非裔美国人种族在这些情况下仍然存在关联，包括未明确的肾衰竭和在调整生物学供体-受体关系后报告的肾功能障碍疾病。非裔美国人在活体肾脏捐赠后更常诊断出肾脏疾病，与捐赠者和接受者的关系无关。需要继续研究以改善非裔美国活体捐赠者肾脏结局的风险分层。
In response to recent studies, a better understanding of the risks of renal complications among African American and biologically-related living kidney donors is needed. We examined a database linking U.S. registry identifiers for living kidney donors (1987-2007) to billing claims from a private health insurer (2000-2007 claims) to identify renal condition diagnoses categorized by International Classification of Diseases 9th Revision (ICD-9) coding. Cox regression with left- and right-censoring was used to estimate cumulative incidence of diagnoses after donation, and associations (adjusted hazards ratios, aHR) with donor traits. Among 4,650 LKD, 13.1% were African American and 76.3% were Caucasian; 76.1% were first-degree relatives of their recipient. By seven years after donation, after adjustment for age and sex, greater proportions of African American compared with Caucasian donors had renal condition diagnoses: chronic kidney disease (12.6% versus 5.6%, aHR 2.32, 95% CI 1.48–3.62), proteinuria (5.7% versus 2.6%, aHR 2.27, 95% CI 1.32–3.89), nephrotic syndrome (1.3% vs 0.1%, aHR 15.7, 95% CI 2.97–83.0), and any renal diagnosis (14.9% vs 9.0%, aHR 1.71, 95% CI 1.23–2.41). While first-degree biological relationship to the recipient was not associated with renal risk, associations of African American race persisted for these conditions and included unspecified renal failure and reported disorders of kidney dysfunction after adjustment for biological donor-recipient relationship. African Americans more commonly develop renal condition diagnoses after living kidney donation, independent of donor-recipient relationship. Continued research is needed to improve risk stratification for renal outcomes among African American living donors.