Bertoni E, Rosati A, Larti A, Merciai C, Zanazzi M, Rosso G, Gallo M, Marcucci R, Salvadori M
Renal Unit, Careggi University Hospital, Florence, Italy.
Transplant Proc. 2006 May;38(4):1024-5. doi: 10.1016/j.transproceed.2006.03.059.
According to a k/DOQI work group, chronic kidney disease (CKD) can be present also in subjects with glomerular filtration rate (GFR) >90 mL/min or a serum creatinine (sCr) below 1.3 mg/dL. The aim of this study was to document the prevalence of clinical or biologic abnormalities among 190 cadaveric renal transplant patients with excellent and stable renal function at 6 months after transplantation as well as 5 years later. The recipients were 82 women and 108 men of mean age at transplantation of 44.56 +/- 11.73 years. All patients were on Neoral-based immunosuppression with at least 5-year follow-up. Mean sCr was 1.18 +/- 0.2 mg/dL. Mean GFR was 78.57 +/- 27.06 mL/min. Systolic blood pressure was >130 mm Hg in 56.6%, although 78.3% of patients were on antihypertensive therapy; 34.3% were anemic; 75.4% had serum cholesterol >200 mg/dL; 62.2% had serum triglyceride levels >170 mg/dL. Serum intact parathyroid hormone >100 pg/mL was observed in 38% of patients and 43% were on vitamin D supplementation, and 11.4% had developed posttransplant diabetes mellitus. With respect to controls, von Willebrand factor was higher in 81.2% (P < .0001; RR = 11); serum homocysteine levels in 75% (P < 0.001; RR = 7.61); PAI-1 in 37.5% (P = .0009; RR = 4). At 5 years posttransplantation we observed an overall improvement in these abnormalities. The vast majority of renal transplant patients with excellent graft function belong to stage 1 of CKD being affected by hypertension, dyslipidemia, anemia, and residual hyperparathyroidism. Markers of endothelial dysfunction were largely abnormal, a condition that could predispose to cardiovascular events.
根据美国肾脏病基金会透析患者临床实践指南（K/DOQI）工作组的观点，肾小球滤过率（GFR）>90 mL/分钟或血清肌酐（sCr）低于1.3 mg/dL的患者也可能患有慢性肾脏病（CKD）。本研究的目的是记录190例尸体肾移植患者在移植后6个月以及5年后肾功能良好且稳定的情况下临床或生物学异常的发生率。受者为82名女性和108名男性，移植时的平均年龄为44.56±11.73岁。所有患者均接受以新山地明为基础的免疫抑制治疗，且至少随访5年。平均sCr为1.18±0.2 mg/dL。平均GFR为78.57±27.06 mL/分钟。56.6%的患者收缩压>130 mmHg，尽管78.3%的患者接受了抗高血压治疗；34.3%的患者贫血；75.4%的患者血清胆固醇>200 mg/dL；62.2%的患者血清甘油三酯水平>170 mg/dL。38%的患者血清完整甲状旁腺激素>100 pg/mL，43%的患者接受维生素D补充治疗，11.4%的患者发生了移植后糖尿病。与对照组相比，81.2%的患者血管性血友病因子水平较高（P<0.0001；相对危险度[RR]=11）；75%的患者血清同型半胱氨酸水平较高（P<0.001；RR=7.61）；37.5%的患者纤溶酶原激活物抑制剂-1（PAI-1）水平较高（P=0.0009；RR=4）。在移植后5年，我们观察到这些异常情况总体有所改善。绝大多数移植肾功能良好的肾移植患者属于CKD 1期，受高血压、血脂异常、贫血和残余甲状旁腺功能亢进影响。内皮功能障碍标志物大多异常，这种情况可能易导致心血管事件。
