Department of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Am J Kidney Dis. 2013 Sep;62(3):577-86. doi: 10.1053/j.ajkd.2013.01.027. Epub 2013 Mar 22.
Most previous studies of living kidney donors have been retrospective and have lacked suitable healthy controls. Needed are prospective controlled studies to better understand the effects of a mild reduction in kidney function from kidney donation in otherwise healthy individuals.
Prospective, controlled, observational cohort study.
SETTING & PARTICIPANTS: Consecutive patients approved for donation at 8 transplant centers in the United States were asked to participate. For every donor enrolled, an equally healthy control with 2 kidneys who theoretically would have been suitable to donate a kidney also was enrolled.
Kidney donation.
At baseline predonation and at 6 months after donation, medical history, vital signs, measured (iohexol) glomerular filtration rate, and other measurements were collected. There were 201 donors and 198 controls who completed both baseline and 6-month visits and form the basis of this report.
Compared with controls, donors had 28% lower glomerular filtration rates at 6 months (94.6 ± 15.1 [SD] vs 67.6 ± 10.1 mL/min/1.73 m(2); P < 0.001), associated with 23% greater parathyroid hormone (42.8 ± 15.6 vs 52.7 ± 20.9 pg/mL; P < 0.001), 5.4% lower serum phosphate (3.5 ± 0.5 vs 3.3 ± 0.5 mg/dL; P < 0.001), 3.7% lower hemoglobin (13.6 ± 1.4 vs 13.1 ± 1.2 g/dL; P < 0.001), 8.2% greater uric acid (4.9 ± 1.2 vs 5.3 ± 1.1 mg/dL; P < 0.001), 24% greater homocysteine (1.2 ± 0.3 vs 1.5 ± 0.4 mg/L; P < 0.001), and 1.5% lower high-density lipoprotein cholesterol (54.9 ± 16.4 vs 54.1 ± 13.9 mg/dL; P = 0.03) levels. There were no differences in albumin-creatinine ratios (5.0 [IQR, 4.0-6.6] vs 5.0 [IQR, 3.3-5.4] mg/g; P = 0.5), office blood pressures, or glucose homeostasis.
Short duration of follow-up and possible bias resulting from an inability to screen controls with kidney and vascular imaging performed in donors.
Kidney donors have some, but not all, abnormalities typically associated with mild chronic kidney disease 6 months after donation. Additional follow-up is warranted.
大多数先前关于活体肾供者的研究都是回顾性的，并且缺乏合适的健康对照。需要进行前瞻性对照研究，以更好地了解肾功能轻度下降对其他健康个体的影响。
前瞻性、对照、观察性队列研究。
在美国 8 个移植中心获得供者批准的连续患者被要求参加。每招募一名供者，就招募一名同样健康的、有 2 个肾脏的对照者，理论上他们也适合捐献一个肾脏。
肾脏捐献。
在捐赠前的基线和捐赠后 6 个月，收集了病史、生命体征、测量的（iohexol）肾小球滤过率和其他测量值。共有 201 名供者和 198 名对照者完成了基线和 6 个月的随访，他们是本报告的基础。
与对照组相比，供者在 6 个月时肾小球滤过率低 28%（94.6±15.1[SD]比 67.6±10.1mL/min/1.73m2；P<0.001），与之相关的甲状旁腺激素高 23%（42.8±15.6比 52.7±20.9pg/mL；P<0.001），血清磷酸盐低 5.4%（3.5±0.5比 3.3±0.5mg/dL；P<0.001），血红蛋白低 3.7%（13.6±1.4比 13.1±1.2g/dL；P<0.001），尿酸高 8.2%（4.9±1.2比 5.3±1.1mg/dL；P<0.001），同型半胱氨酸高 24%（1.2±0.3比 1.5±0.4mg/L；P<0.001），高密度脂蛋白胆固醇低 1.5%（54.9±16.4比 54.1±13.9mg/dL；P=0.03）。白蛋白/肌酐比值（5.0[IQR，4.0-6.6]比 5.0[IQR，3.3-5.4]mg/g；P=0.5）、办公血压或葡萄糖稳态无差异。
随访时间短，以及由于无法对供者进行肾脏和血管成像检查而导致的对照选择偏倚。
肾脏捐献者在捐赠后 6 个月时存在一些，但不是所有，与轻度慢性肾脏病相关的异常。需要进一步随访。
