Jiménez Alvaro S, Marcén R, Teruel J L, Fernández Rodríguez A, Pascual J, Galeano C, Villacorta J, Burgos F J, Ortuño J
Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain.
Transplant Proc. 2009 Jul-Aug;41(6):2409-11. doi: 10.1016/j.transproceed.2009.06.107.
The Kidney Disease Quality Initiative (K/DOQI) of the National Kidney Foundation has published guidelines for the diagnosis and management of chronic kidney disease (CKD). Renal transplant recipients frequently have CKD and complications similar to native kidney disease patients. The purpose of the present study was to compare the management of CKD complications of transplant recipients and nontransplant patients.
Eighty three renal transplant recipients with CKD stages 4T and 5T were compared with 83 nontransplant CKD patients matched by CKD stage.
There were no differences between the groups in serum hemoglobin, prevalence of anemia, and percentage of patients treated with erythropoiesis-stimulating agents, but serum ferritin levels were higher among recipients (186.3 +/- 161.3 vs 119.1 +/- 113.4 ng/mL; P = .003). Mean blood pressure (BP) was similar in both groups but a systolic BP > 130 mm Hg was more frequent among recipients (83.3% vs 72.6%). More recipients were treated with either angiotensin-converting enzyme (ACE)-inhibitors or angiotensin receptor antagonist (43.3% vs 8.4%; P < .001). Low-density lipoprotein cholesterol was lower in recipients (108.9 +/- 30.3 vs 120.8 +/- 39.5 mg/dL; P = .033) and a higher percentage was on statin treatment (44.6% vs 28.9%; P = .053). Serum calcium was higher in transplant recipients (9.5 +/- 0.8 vs 8.9 +/- 0.7 mg/dL; P < .005) and phosphate was lower (3.9 +/- 0.9 vs 4.2 +/- 1.1; P = .043); there were no differences in intact parathyroid hormone blood levels.
The management of renal transplant recipients is no worse than that of nontransplant patients. However, in both populations, some parameters are far from the target recommended by the guidelines.
美国国家肾脏基金会的肾脏病质量倡议（K/DOQI）已发布慢性肾脏病（CKD）的诊断和管理指南。肾移植受者常患有CKD及与原发性肾病患者相似的并发症。本研究的目的是比较移植受者和非移植患者CKD并发症的管理情况。
83例4T期和5T期CKD肾移植受者与83例按CKD分期匹配的非移植CKD患者进行比较。
两组在血清血红蛋白、贫血患病率及接受促红细胞生成素治疗的患者百分比方面无差异，但受者的血清铁蛋白水平较高（186.3±161.3 vs 119.1±113.4 ng/mL；P = 0.003）。两组的平均血压（BP）相似，但收缩压>130 mmHg在受者中更常见（83.3% vs 72.6%）。更多受者接受了血管紧张素转换酶（ACE）抑制剂或血管紧张素受体拮抗剂治疗（43.3% vs 8.4%；P < 0.001）。受者的低密度脂蛋白胆固醇较低（108.9±30.3 vs 120.8±39.5 mg/dL；P = 0.033），接受他汀类药物治疗的百分比更高（44.6% vs 28.9%；P = 0.053）。移植受者的血清钙较高（9.5±0.8 vs 8.9±0.7 mg/dL；P < 0.005），磷酸盐较低（3.9±0.9 vs 4.2±1.1；P = 0.043）；完整甲状旁腺激素血水平无差异。
肾移植受者的管理并不比非移植患者差。然而，在这两个人群中，一些参数远未达到指南推荐的目标。
