活体肾供体血脂谱的临床评估。

Clinical assessment of lipid profiles in live kidney donors.

作者信息

Yoon Y E, Choi K H, Kim K H, Yang S C, Han W K

机构信息

Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea.

出版信息

Transplant Proc. 2015 Apr;47(3):584-7. doi: 10.1016/j.transproceed.2014.12.035.

DOI:10.1016/j.transproceed.2014.12.035

PMID:25891691

Abstract

BACKGROUND

Abnormal serum lipid profiles are an issue in chronic kidney disease (CKD), but the clinical ramifications of dyslipidemia in live kidney donors are unclear. Thus, we explored the relationship between serum lipids and residual renal function in living donors post-nephrectomy.

METHODS

Charts of living donors who underwent nephrectomy between January 2010 and March 2013 were reviewed, targeting those with 6-month follow-up examinations at minimum. Altogether, 282 donors were studied, examining total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels assayed before donation by standard techniques. Median follow-up time was 14 months. The relationship between postoperative renal function and allograft biopsy results was assessed. Recursive partitioning was applied to identify optimal cut-off points for each parameter.

RESULTS

Median (interquartile range) serum TC, TG, LDL, and HDL levels were 183 (161-205) mg/dL, 86 (63-131) mg/dL, 108 (92-128) mg/dL, and 53 (44-62) mg/dL, respectively. The glomerular filtration rate at last follow-up was associated with TC (r = -0.187; P = .002) and LDL (r = -0.172; P = .005) levels, but showed no correlation with TG and HDL. Root nodes of TC and LDL determinations in recursive partitioning were 170.5 mg/dL and 80.5 mg/dL, respectively, serving as thresholds for further evaluation. On logistic regression analysis, the likelihood of CKD (glomerular filtration rate < 60 mL/min/1.73 m(2)) at last follow-up was greater in donors with elevated TC and LDL levels (odds ratio = 1.96 and 3.33; P = .021 and .029, respectively).

CONCLUSION

Kidney donors with serum TC and LDL elevations require close observation, given their demonstrable predisposition to CKD after donation.

摘要

背景

血清脂质谱异常是慢性肾脏病（CKD）中的一个问题，但活体肾供者血脂异常的临床影响尚不清楚。因此，我们探讨了肾切除术后活体供者血清脂质与残余肾功能之间的关系。

方法

回顾了2010年1月至2013年3月期间接受肾切除术的活体供者的病历，目标是至少有6个月随访检查的供者。总共研究了282名供者，通过标准技术检测捐献前的总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）水平。中位随访时间为14个月。评估了术后肾功能与同种异体肾活检结果之间的关系。应用递归分割法确定每个参数的最佳切点。

结果

血清TC、TG、LDL和HDL水平的中位数（四分位间距）分别为183（161 - 205）mg/dL、86（63 - 131）mg/dL、108（92 - 128）mg/dL和53（44 - 62）mg/dL。最后一次随访时的肾小球滤过率与TC（r = -0.187；P = .002）和LDL（r = -0.172；P = .005）水平相关，但与TG和HDL无相关性。递归分割中TC和LDL测定的根节点分别为170.5 mg/dL和80.5 mg/dL，作为进一步评估的阈值。在逻辑回归分析中，最后一次随访时TC和LDL水平升高的供者发生CKD（肾小球滤过率<60 mL/min/1.73 m²）的可能性更大（优势比分别为1.96和3.33；P分别为.021和.029）。