Abbott Kevin C, Yuan Christina M, Taylor Allen J, Cruess David F, Agodoa Lawrence Y C
Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
J Am Soc Nephrol. 2003 Sep;14(9):2358-65. doi: 10.1097/01.asn.0000083008.25305.67.
Renal insufficiency has been identified as a risk factor for graft loss and death after renal transplantation but has not been consistently linked to early, nonfatal, hospitalized heart disease (HHD). With the United States Renal Data System database, 29,597 patients who received a kidney transplant between January 1, 1996, and July 31, 2000, with Medicare as the primary payer, and were monitored until December 31, 2000, were studied. Cox proportional-hazards regression models were used to calculate the association of recipient estimated GFR (eGFR) at 1 yr after renal transplantation, as determined with the Modification of Diet in Renal Disease formula, with hospitalization for treatment of acute coronary syndromes (ACS) (International Classification of Diseases, version 9, code 410.x or 411.x) or congestive heart failure (CHF) (code 428.x) 1 to 3 yr after renal transplantation. Rates of ACS and CHF were 2.2 and 4.9%, respectively, for patients with eGFR of <44.8 ml/min per 1.73 m(2), compared with 1.2 and 1.4% for patients with eGFR of >69.7 ml/min per 1.73 m(2). Reduced eGFR (<44.8 ml/min per 1.73 m(2), compared with >69.7 ml/min per 1.73 m(2)) at the end of the first 1 yr after transplantation was independently associated with increased risks of both ACS (adjusted hazard ratio, 2.16; 95% confidence interval, 1.39 to 3.35) and CHF (adjusted hazard ratio, 2.95; 95% confidence interval, 2.24 to 3.90). It was concluded that early renal insufficiency (approximately stage 3 chronic kidney disease) was associated with higher rates of HHD 1 to 3 yr after kidney transplantation. Preservation of renal function after renal transplantation may reduce the rates of HHD, and renal transplant recipients with reduced eGFR should be considered at high risk of developing cardiovascular disease.
肾功能不全已被确认为肾移植后移植物丢失和死亡的一个风险因素，但一直未被认为与早期非致命性住院心脏病（HHD）存在关联。利用美国肾脏数据系统数据库，对1996年1月1日至2000年7月31日期间接受肾移植、以医疗保险作为主要支付方且被监测至2000年12月31日的29597例患者进行了研究。采用Cox比例风险回归模型来计算肾移植后1年时根据肾病饮食改良公式确定的受者估计肾小球滤过率（eGFR）与肾移植后1至3年因急性冠状动脉综合征（ACS）（国际疾病分类第9版，编码410.x或411.x）或充血性心力衰竭（CHF）（编码428.x）住院治疗之间的关联。eGFR＜44.8 ml/（min·1.73 m²）的患者，ACS和CHF发生率分别为2.2%和4.9%，而eGFR＞69.7 ml/（min·1.73 m²）的患者，ACS和CHF发生率分别为1.2%和1.4%。移植后第1年年底时eGFR降低（＜44.8 ml/（min·1.73 m²）与＞69.7 ml/（min·1.73 m²）相比）与ACS（校正风险比为2.16；95%置信区间为1.39至3.35）和CHF（校正风险比为2.95；95%置信区间为2.24至3.90）风险增加独立相关。得出的结论是，早期肾功能不全（约3期慢性肾脏病）与肾移植后1至3年较高的HHD发生率相关。肾移植后保留肾功能可能会降低HHD发生率，eGFR降低的肾移植受者应被视为发生心血管疾病的高危人群。
