作为慢性肾脏病队列的肾脏捐献者的心血管疾病风险。

Risk of cardiovascular disease in kidney donors as a chronic kidney disease cohort.

机构信息

Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.

出版信息

Mol Med Rep. 2012 Jan;5(1):7-11. doi: 10.3892/mmr.2011.629. Epub 2011 Oct 12.

DOI:10.3892/mmr.2011.629

PMID:21993905

Abstract

Kidney donors are a chronic kidney disease (CKD) cohort virtually guaranteed to have a low risk of CKD progression, as they are screened for CKD risk factors beforehand. However, there has been no evidence of cardiovascular disease (CVD), which is an outcome of CKD, for these donors. In this study, the conditions of CKD in kidney donors were investigated and the risk of CVD was estimated using nephrectomy patients, who are thought to have a crude risk of CKD progression, as a model. In 86 kidney donors, estimated glomerular filtration rates (eGFR) were measured, and they were classified according to the CKD stage. Plasma brain natriuretic peptide (BNP) concentrations and urinary albumin (mg/g Cre) levels were also measured as markers for cardiovascular evaluation. A total of 200 nephrectomy patients were similarly classified according to the CKD stage. A multivariate regression analysis was carried out to evaluate the risk factors of CVD. Among the kidney donors, 4.9% were CKD stage 1, 24.6% stage 2 and 70.5% stage 3. Among the nephrectomy patients, 20.5% were CKD stage 2, 66.6% stage 3, 9.5% stage 4 and 3.4% stage 5. Plasma BNP concentrations of the donors were significantly higher compared to those of healthy volunteers (24.5±24.9 vs. 8.6±7.6 pg/ml, p<0.0001). In addition, approximately 16% of the donors had microalbuminuria and 4% had overt proteinuria. The prevalence of new-onset CVD was 2.3% for the donors and 10% for the nephrectomy patients (p=0.0281). By logistic regression analysis of the nephrectomy patients, proteinuria, age and hypertension were significantly independent risk factors for new-onset CVD. Our findings suggest that the risks of CVD may be increased in kidney donors. In our analysis of new-onset CVD in nephrectomy patients, proteinuria, age and hypertension were significantly related factors. This suggests that in the follow-up of kidney donors, those who present these conditions from before or during follow-up should be carefully monitored.

摘要

肾移植供体在进行 CKD 风险因素筛查后，几乎可以确定患有 CKD 进展的风险较低，因为他们是慢性肾脏病（CKD）队列。然而，这些供体没有心血管疾病（CVD）的证据，而 CVD 是 CKD 的结果。在这项研究中，研究了肾移植供体的 CKD 状况，并使用被认为具有 CKD 进展的粗略风险的肾切除术患者作为模型来估计 CVD 的风险。在 86 名肾移植供体中，测量了估算肾小球滤过率（eGFR），并根据 CKD 分期进行了分类。还测量了血浆脑钠肽（BNP）浓度和尿白蛋白（mg/g Cre）水平作为心血管评估的标志物。同样根据 CKD 分期将 200 名肾切除术患者进行了分类。进行了多变量回归分析以评估 CVD 的危险因素。在肾移植供体中，4.9%为 CKD 1 期，24.6%为 CKD 2 期，70.5%为 CKD 3 期。在肾切除术患者中，20.5%为 CKD 2 期，66.6%为 CKD 3 期，9.5%为 CKD 4 期，3.4%为 CKD 5 期。供体的血浆 BNP 浓度明显高于健康志愿者（24.5±24.9 vs. 8.6±7.6 pg/ml，p<0.0001）。此外，大约 16%的供体有微量白蛋白尿，4%有显性蛋白尿。供体新发 CVD 的患病率为 2.3%，肾切除术患者为 10%（p=0.0281）。通过对肾切除术患者进行逻辑回归分析，蛋白尿、年龄和高血压是新发 CVD 的显著独立危险因素。我们的研究结果表明，CVD 的风险可能会增加肾移植供体。在我们对肾切除术患者新发 CVD 的分析中，蛋白尿、年龄和高血压是显著相关因素。这表明，在肾移植供体的随访中，那些在随访前或随访期间出现这些情况的人应密切监测。