Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
Am J Kidney Dis. 2011 Mar;57(3):466-75. doi: 10.1053/j.ajkd.2010.10.054. Epub 2011 Jan 22.
Whether chronic kidney disease (CKD) staging provides a useful framework for predicting outcomes after kidney transplant is unclear.
Retrospective cohort study.
SETTING & PARTICIPANTS: We used data from the Patient Outcomes in Renal Transplantation (PORT) Study, including 13,671 transplants from 12 centers during 10 years of follow-up.
Estimated glomerular filtration rate (eGFR; in milliliters per minute per 1.73 m(2)) at 12 months posttransplant.
All-cause graft failure (a composite end point consisting of return to dialysis therapy, pre-emptive retransplant, or death with function), death-censored graft failure, and death with a functioning graft.
The relationship between 12-month eGFR and subsequent graft outcomes through 10 years posttransplant was assessed using Cox proportional hazards analyses.
Stage 3 included 63% of patients and was subdivided into stages 3a (eGFR, 45-59 mL/min/1.73 m(2); 34%) and 3b (eGFR, 30-44 mL/min/1.73 m(2); 29%). Compared with stage 2 (eGFR, 60-89 mL/min/1.73 m(2); 24%), adjusted Cox proportional HRs for graft failure were 1.12 (95% CI, 1.01-1.24; P = 0.04) for stage 3a, 1.50 (95% CI, 1.35-1.66; P < 0.001) for stage 3b, 2.86 (95% CI, 2.53-3.22; P < 0.001) for stage 4 (eGFR, 15-29 mL/min/1.73 m(2); 9%), and 13.2 (95% CI, 10.7-16.4; P < 0.001) for stage 5 (eGFR <15 mL/min/1.73 m(2); 1%). For stage 1 (eGFR ≥ 90 mL/min/1.73 m(2); 3%), risk of graft failure was increased (1.41 [95% CI, 1.13-1.75]; P < 0.001), likely due to serum creatinine associations independent of kidney function. Similar associations were seen between CKD stages and mortality.
Retrospective study; lack of gold-standard measurements of true GFR; lack of measures of comorbidity, inflammation, muscle mass, proteinuria, and other noncreatinine markers of eGFR.
CKD stages validated in the general population provide a useful framework for predicting outcomes after kidney transplant.
慢性肾脏病（CKD）分期是否为预测肾移植后结局提供了有用的框架仍不清楚。
回顾性队列研究。
我们使用了来自肾脏移植患者结局（PORT）研究的数据，包括 12 个中心在 10 年随访期间的 13671 例移植。
移植后 12 个月的估算肾小球滤过率（eGFR；以毫升/分钟/1.73m²表示）。
全因移植物失败（包括返回透析治疗、抢先再次移植或带功能的死亡）、死亡校正移植物失败和带功能移植物的死亡。
通过 Cox 比例风险分析评估 12 个月时的 eGFR 与移植后 10 年的后续移植物结局之间的关系。
第 3 期包括 63%的患者，进一步分为第 3a 期（eGFR，45-59ml/min/1.73m²；34%）和第 3b 期（eGFR，30-44ml/min/1.73m²；29%）。与第 2 期（eGFR，60-89ml/min/1.73m²；24%）相比，调整后的 Cox 比例风险比为：第 3a 期为 1.12（95%CI，1.01-1.24；P=0.04），第 3b 期为 1.50（95%CI，1.35-1.66；P<0.001），第 4 期（eGFR，15-29ml/min/1.73m²；9%）为 2.86（95%CI，2.53-3.22；P<0.001），第 5 期（eGFR<15ml/min/1.73m²；1%）为 13.2（95%CI，10.7-16.4；P<0.001）。第 1 期（eGFR≥90ml/min/1.73m²；3%）移植物失败风险增加（1.41[95%CI，1.13-1.75]；P<0.001），这可能是由于血清肌酐与肾功能无关的独立关联。在 CKD 分期和死亡率之间也观察到类似的关联。
回顾性研究；缺乏真正的 GFR 的金标准测量；缺乏合并症、炎症、肌肉量、蛋白尿和其他非肌酐 eGFR 标志物的测量。
在一般人群中验证的 CKD 分期为预测肾移植后结局提供了有用的框架。
