Perioperative and long-term risks following nephrectomy in older live kidney donors

项目摘要 接受活体供肾切除术的老年人（年龄≥55岁）的数量在过去两年中翻了两番。 几十年来，这一趋势可能会继续下去。然而，在我们的理解中存在着知识差距， 老年捐赠者对身体压力的耐受性。除了与年龄相关的易受手术压力的影响外， 人群可能有显着的肾小球衰老，适应性反应不足的50%的损失， 肾单位质量，因此，在其一生中患CKD的可能性非常高。大约80%的老年捐赠者 献血后GFR<60 ml/min/1.73m2，符合CKD标准定义。作为年长的捐赠者 随着CKD进展，他们可能变得虚弱，因此住院的风险增加。 没有研究集中在识别老年人的弹性的临床签名， 供肾切除术肾切除术直接影响肾系统，其弹性可能会影响肾功能。 老年捐赠者的健康和福祉。提供者与这些潜在捐助者的讨论应侧重于 病人最重要的问题：“我能安全地捐献我的肾吗？”而不是人口水平的问题， 2017年KDIGO指南：“年轻供体中有多少ESRD事件可以通过移植来避免 老年捐赠者呢？” 我们提出以下科学目标：1。量化ESRD和死亡率的捐赠归因风险， 老年捐赠者; 2.描述老年供体与老年非供体的住院率; 3.到 在老年献血者中实施终末期肾病、死亡率和定点住院的风险计算器。 本提案概述了Abimereki Muzaale，MD，MPH的详细培训计划。简而言之， 约翰霍普金斯大学临床研究项目博士学位，深入的课程工作 在老龄化研究，和指导计划共同编制的主要研究者和一个团队， 在肾脏疾病，老龄化研究，信息科学的专业知识，并指导初级教师。这 团队将帮助候选人满足以下职业目标：（1）接受老龄化研究的正式培训;（2） 申请并获得R 01赠款资金;（3）过渡到独立。 我们的努力将最终导致创建在线风险计算器， 候选人和供应商关于捐赠的适当性。Muzaale博士将学习如何哨兵住院 老年捐赠者老龄化队列中的事件留下了现有和缺失数据的足迹，这些数据将被系统地 在准备R 01提案中至关重要，该提案旨在从实验室，物理， 认知和其他测试。

PROJECT SUMMARY The number of older adults (aged≥55) undergoing live donor nephrectomy has quadrupled over the last two decades and this trend is likely to continue. However, a knowledge gap exists in our understanding of the resiliencies to physical stress in older donors. Beyond age-related vulnerability to surgical stress, this aging population may have significant glomerular senescence, an inadequate adaptive response to the 50% loss of nephron mass and, as such, a very high likelihood of CKD in their lifetime. Approximately 80% of older donors have a postdonation GFR<60 ml/min/1.73m2 and meet the standard definition of CKD. As older donors progress towards CKD, they are likely to become frail and, as such, at increased risk of hospitalization. No study has focused on the identification of clinical signatures of resiliency in older persons undergoing live donor nephrectomy. The renal system is directly impacted by nephrectomy and its resiliency may affect the health and well-being of older donors. Provider discussions with these potential donors should focus on the patient's most important question: “Can I safely donate my kidney?” not the population-level question asked by the 2017 KDIGO guidelines: “How many ESRD events in younger donors may be averted by transplanting older donors instead?” We propose the following scientific aims: 1. To quantify donation-attributable risk of ESRD and mortality in older donors; 2. To describe the prevalence of hospitalizations in older donors vs. older nondonors; and 3. To implement a risk calculator for ESRD, mortality and sentinel hospitalization in older donors. A detailed training plan for Abimereki Muzaale, MD, MPH is outlined in this proposal. In brief, it includes enrollment in the PhD in Clinical Investigation Program at The Johns Hopkins University, in-depth course work in aging research, and a mentorship plan jointly prepared by the principal investigator and a team with expertise in kidney disease, aging research, information sciences, and the mentorship of junior faculty. This team will help the candidate meet the following career goals: (1) Receive formal training in aging research; (2) Apply for and obtain R01 grant funding; and (3) Transition to independence. Our efforts will culminate in the creation of online risk calculators that inform the conversation between candidates and providers about the propriety of donation. Dr. Muzaale will learn how sentinel hospitalization events in an aging cohort of older donors leave a footprint of present and missing data that will be methodically crucial in preparing an R01 proposal to characterize trajectories of resiliency from laboratory, physical, cognitive, and other tests.