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):3239-41. doi: 10.1016/j.transproceed.2009.07.077.
Patients with cardiovascular disease often have renal dysfunction from concomitant diabetes mellitus, hypertension, or congestive heart failure. Glomerular filtration rate (GFR) less than 60 mL/min is predictive of premature death due to cardiovascular disease. The objective of the present study was to assess the prevalence of kidney dysfunction in 162 heart transplant recipients using estimated GFR according to the Cockcroft-Gault and the simplified Modification of Diet in Renal Disease (MDRD) formulas or creatinine clearance (24-hour urine collection). Normal serum creatinine concentrations were noted in 46% of patients. Mean (SD) GFR was 62.92 (31.04) mL/min using the Cockcroft-Gault formula, 55.38 (26.74) mL/min using the MDRD formula, and 62.62 (35.61) mL/min according to creatinine clearance. Using the Cockcroft-Gault formula, a diagnosis of stage 2 chronic kidney disease (CKD) (GFR 60-89 mL/min) was made in 92 patients (56.8%), stage 3 (GFR 30-59 mL/min) in 62 patients (38.3%), and stage 4 (GFR 15-29 mL/min) in 14 patients (8.6%). Using the MDRD formula, stage 2 CKD was present in 52 patients (28.5%), stage 3 in 77 (51.1%), and stage 4 in 28 (17.3%). According to creatinine clearance, stage 2 CKD was noted in 10 patients (6.2%), stage 3 in 114 (73.3%), and stage 4 in 21 (13.0%). We conclude that the prevalence of CKD is extremely high in heart transplant recipients. Evaluation of renal function is important to select the appropriate technique to reduce cardiovascular risk. A multidisciplinary approach in heart transplant recipients should include a nephrologist.
患有心血管疾病的患者常因合并糖尿病、高血压或充血性心力衰竭而出现肾功能不全。肾小球滤过率（GFR）低于60 mL/分钟可预测心血管疾病导致的过早死亡。本研究的目的是使用根据Cockcroft-Gault公式和简化的肾脏疾病饮食改良（MDRD）公式估算的GFR或肌酐清除率（24小时尿液收集）来评估162名心脏移植受者的肾功能不全患病率。46%的患者血清肌酐浓度正常。使用Cockcroft-Gault公式时，平均（标准差）GFR为62.92（31.04）mL/分钟，使用MDRD公式时为55.38（26.74）mL/分钟，根据肌酐清除率计算为62.62（35.61）mL/分钟。使用Cockcroft-Gault公式，92名患者（56.8%）被诊断为2期慢性肾脏病（CKD）（GFR 60 - 89 mL/分钟），62名患者（38.3%）为3期（GFR 30 - 59 mL/分钟），14名患者（8.6%）为4期（GFR 15 - 29 mL/分钟）。使用MDRD公式时，2期CKD患者有52名（28.5%），3期有77名（51.1%），4期有28名（17.3%）。根据肌酐清除率，10名患者（6.2%）为2期CKD，114名（73.3%）为3期，21名（13.0%）为4期。我们得出结论，心脏移植受者中CKD的患病率极高。评估肾功能对于选择适当的技术以降低心血管风险很重要。心脏移植受者的多学科方法应包括一名肾病学家。
