Przybylowski P, Malyszko J, Malyszko J S
Department of Cardiac Surgery and Transplantology, Collegium Medicum, Jagiellonian University, Cracow, Pradnicka 80, Poland.
Transplant Proc. 2009 Oct;41(8):3235-8. doi: 10.1016/j.transproceed.2009.07.073.
Cardiovascular disease and kidney disease seem to be lethally synergistic, both approaching the level of epidemics. Patients with cardiovascular disease often have impaired kidney function; on the other hand, cardiovascular disease is the single best predictor of mortality among patients with chronic kidney disease. The risk in a patient with moderately impaired renal function is comparable in magnitude to that of a patient with diabetes mellitus. The aim of this study was to assess risk factors for kidney dysfunction among 162 prevalent heart transplant (OHT) recipients (127 males and 22 females). Stages of chronic kidney disease were defined according to Kidney Disease Outcomes Quality Initiative guidelines using the estimated glomerular filtration rate (GFR). Mean serum creatinine in this population was 1.70 +/- 1.08 mg/dL (range, 0.54-9.34). The mean age was 54 +/- 14 years and the average time after transplantation was 106 +/- 52 months (range, 10-210). Mean GFR was 62.92 +/- 31.04 mL/min (Cockcroft-Gault formula), 55.38 +/- 26.74 mL/min (MDRD), and 62.62 +/- 35.61 mL/min (creatinine clearance). Estimated GFR, creatinine clearance, and serum creatinine correlated upon univariate analysis with hemoglobin, red blood cell count, age, time after transplantation, ejection fraction, N-terminal prohormone brain natriuretic peptide, and use of calcineurin inhibitors. Upon multiple regression analysis predictors of kidney function (GFR) were age (beta value, -0.47; P < .001), time after transplantation (beta value, -0.22; P = .03), and hemoglobin (beta value, 0.31; P = .03), explaining 51% of the variation among GFR values in this group. When GFR was substituted with creatinine clearance, the results were similar. Among heart transplant recipients, kidney function was predominantly dependent on age and time after transplantation (both nonmodifiable causes), as well as anemia (which may be modified).
心血管疾病和肾脏疾病似乎具有致命的协同作用，二者都接近流行病的程度。心血管疾病患者常常肾功能受损；另一方面，心血管疾病是慢性肾脏病患者死亡率的最佳单一预测指标。肾功能中度受损患者的风险程度与糖尿病患者相当。本研究的目的是评估162例心脏移植（原位心脏移植）受者（127例男性和22例女性）中肾功能不全的危险因素。根据肾脏疾病改善全球预后（KDIGO）指南，使用估计肾小球滤过率（GFR）来定义慢性肾脏病的分期。该人群的平均血清肌酐为1.70±1.08mg/dL（范围为0.54 - 9.34）。平均年龄为54±14岁，移植后的平均时间为106±52个月（范围为10 - 210个月）。平均GFR为62.92±31.04mL/min（Cockcroft - Gault公式）、55.38±26.74mL/min（MDRD公式）以及62.62±35.61mL/min（肌酐清除率）。在单因素分析中，估计GFR、肌酐清除率和血清肌酐与血红蛋白、红细胞计数、年龄、移植后时间、射血分数、N末端脑钠肽前体以及钙调神经磷酸酶抑制剂的使用相关。在多元回归分析中，肾功能（GFR）的预测因素为年龄（β值， - 0.47；P <.001）、移植后时间（β值， - 0.22；P =.03）和血红蛋白（β值，0.31；P =.03），解释了该组GFR值变异的51%。当用肌酐清除率替代GFR时，结果相似。在心脏移植受者中，肾功能主要取决于年龄和移植后时间（二者均为不可改变的因素）以及贫血（这可能是可改变的）。
