Hendawy A, Pouteil-Noble C, Villar E, Boissonnat P, Sebbag L
Nephrology-Transplantation Unit, Lyon-Sud Hospital, Pierre-Bénite Cedex, France.
Transplant Proc. 2005 Mar;37(2):1352-4. doi: 10.1016/j.transproceed.2004.12.276.
The aim of the study was to analyze the etiology, the factors for progression of chronic renal failure to end-stage-renal disease (ESRD), and the influence of ESRD on the survival rate among a cohort of 59 heart transplant patients (HTP) referred for the management of chronic renal failure (CRF). At the time of the first nephrology consultation (6 +/- 4.25 years after cardiac transplantation) the mean creatininemia was 261.5 +/- 99 micromol/L and mean creatinine clearance (Cockcroft formula) was 32 +/- 15 mL/min. The cause of CRF were calcineurin inhibitor toxicity in 38.9% of patients, vascular events in 15.2%, hemolytic uremic syndrome in 5%, membranous glomerulopathy in 3.3%, diabetes in two patients, focal/segmental glomerulosclerosis in 3.3%, renal hypoplasia in 1.7%, and unknown in 27%. Evolution to ESRD occurred in 38.9% of patients: 17 patients started hemodialysis, three peritoneal dialysis, and two received a preemptive kidney transplantation. Creatininemia (micromol/L) at the time of nephrology referral was 229.2 +/- 72.6 versus 315.8 +/- 113.4 (P < .001) and creatinine clearance (mL/min) was 34.9 +/- 15.1 versus 27.3 +/- 13.7 (P = .049) for patients with CRF versus ESRD, respectively. Both proteinuria (g/24 hours) of 1 +/- 2.2 versus 2.3 +/- 1.8 (P = .02) and tobacco use in 35.1% versus 54.4% (P = .045) were significantly associated with progression of CRF, while age at the time of heart transplantation, cause of cardiac failure and renal failure, high blood pressure, type 2 diabetes, dyslipidemia, alcoholism, cirrhosis, and cerebral vascular accident were not. Death occurred in 18 HTP: 50% of patients with ESRD and 18.5% of patients with CRF-a 2.6 relative risk of of death in HTP patients with ESRD compared with HTP with CRF only (P < .01).
本研究的目的是分析59例因慢性肾衰竭（CRF）前来接受治疗的心脏移植患者（HTP）队列中慢性肾衰竭的病因、进展至终末期肾病（ESRD）的因素以及ESRD对生存率的影响。在首次肾病会诊时（心脏移植后6±4.25年），平均血肌酐水平为261.5±99微摩尔/升，平均肌酐清除率（Cockcroft公式）为32±15毫升/分钟。CRF的病因中，38.9%的患者是钙调神经磷酸酶抑制剂毒性，15.2%是血管事件，5%是溶血性尿毒症综合征，3.3%是膜性肾小球病，两名患者是糖尿病，3.3%是局灶节段性肾小球硬化，1.7%是肾发育不全，27%病因不明。38.9%的患者进展为ESRD：17例患者开始血液透析，3例进行腹膜透析，2例接受了抢先肾移植。肾病会诊时，CRF患者的血肌酐水平（微摩尔/升）为229.2±72.6，而ESRD患者为315.8±113.4（P<0.001）；肌酐清除率（毫升/分钟）分别为34.9±15.1和27.3±13.7（P = 0.049）。蛋白尿（克/24小时）为1±2.2与2.3±1.8（P = 0.02）以及吸烟率为35.1%与54.4%（P = 0.045）均与CRF进展显著相关，而心脏移植时的年龄、心力衰竭和肾衰竭的病因、高血压、2型糖尿病、血脂异常、酗酒、肝硬化和脑血管意外则无此关联。18例HTP患者死亡：ESRD患者中有50%，CRF患者中有18.5%——与仅患有CRF的HTP患者相比，ESRD的HTP患者死亡相对风险为2.6（P<0.01）。
