活体肾供体候选人的肾衰竭风险预测
Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate.
作者信息
Grams Morgan E, Sang Yingying, Levey Andrew S, Matsushita Kunihiro, Ballew Shoshana, Chang Alex R, Chow Eric K H, Kasiske Bertram L, Kovesdy Csaba P, Nadkarni Girish N, Shalev Varda, Segev Dorry L, Coresh Josef, Lentine Krista L, Garg Amit X
机构信息
From the Division of Nephrology, Johns Hopkins University School of Medicine (M.E.G.), the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.E.G., Y.S., K.M., S.B., J.C.), and the Departments of Surgery and Epidemiology, Johns Hopkins University (E.K.H.C., D.L.S.) - all in Baltimore; the Division of Nephrology, Tufts Medical Center, Boston (A.S.L.); the Division of Nephrology, Geisinger Medical Center, Danville, PA (A.R.C.); the Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis (B.L.K.); Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center - both in Memphis (C.P.K.); the Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (G.N.N.); Medical Division, Maccabi Healthcare Services and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (V.S.); Centers for Abdominal Transplantation and Outcomes Research, Saint Louis University, St. Louis (K.L.L.); and the Departments of Medicine and Epidemiology and Biostatistics, Western University, and the Institute for Clinical Evaluative Sciences - both in London, ON, Canada (A.X.G.).
出版信息
N Engl J Med. 2016 Feb 4;374(5):411-21. doi: 10.1056/NEJMoa1510491. Epub 2015 Nov 6.
BACKGROUND
Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney.
METHODS
We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States.
RESULTS
A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation.
CONCLUSIONS
Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).
背景
对活体肾供体候选人的评估依赖于对终末期肾病（ESRD）个体风险因素的筛查。为支持基于实证的供体选择方法，我们开发了一种工具，该工具同时纳入多种健康特征，以估计一个人在不捐献肾脏的情况下患ESRD的可能长期风险。
方法
我们使用了对七个普通人群队列的荟萃分析中的风险关联，根据美国ESRD的人群水平发病率和死亡率进行校准，以根据10种人口统计学和健康特征预测不捐献肾脏者中ESRD的估计长期发病率。然后，我们将15年的预测结果与美国52998名活体肾供体的观察风险进行了比较。
结果
七个队列中的4933314名参与者接受了中位数为4至16年的随访。对于一名40岁、健康特征与年龄匹配的肾供体相似的人，在不捐献的情况下，ESRD风险的15年预测因种族和性别而异；黑人男性的风险为0.24%，黑人女性为0.15%，白人男性为0.06%，白人女性为0.04%。在估计的肾小球滤过率较低、蛋白尿较高、高血压、当前或既往吸烟、糖尿病和肥胖的情况下，风险预测更高。在基于模型的终生预测中，ESRD风险在最年轻年龄组的人群中最高，尤其是年轻黑人。美国肾供体捐献后15年的观察风险比不捐献时的预测风险高3.5至5.3倍。
结论
多种人口统计学和健康特征可共同用于估计活体肾供体候选人患ESRD的预测长期风险，并为肾供体的接受标准提供参考。（由美国国立糖尿病、消化和肾脏疾病研究所及其他机构资助。）
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