Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada.
Kidney Int. 2017 Aug;92(2):470-478. doi: 10.1016/j.kint.2017.01.028. Epub 2017 Mar 31.
In 2012, the KDIGO guidelines updated the classification system for chronic kidney disease to include albuminuria. Whether this classification system predicts adverse clinical outcomes among kidney transplant recipients is unclear. To evaluate this, we conducted a retrospective study using linked databases in Alberta, Canada to follow kidney transplant recipients from 2002-2011. We examined the association between an estimated glomerular filtration rate (eGFR of 60 or more, 45-59, 30-44, 15-29 mL/min/1.73 m) and albuminuria (normal, mild, heavy) at one year post-transplant and subsequent mortality and graft loss. There were 900 recipients with a functioning graft and at least one outpatient serum creatinine and urine protein measurement at one year post-transplant. The median age was 51.2 years, 38.7% were female, and 52% had an eGFR of 60 mL/min/1.73 m or more. The risk of all-cause mortality and death-censored graft loss was increased in recipients with reduced eGFR or heavier albuminuria. The adjusted incidence rate per 1000 person-years of all-cause mortality for recipients with an eGFR of 15-29 mL/min/1.73 m and heavy albuminuria vs. an eGFR 60 mL/min/1.73 m or more and normal protein excretion was 117 (95% confidence interval 38-371) vs. 15 (9-23) (rate ratio 8). Corresponding rates for death-censored graft loss were 273 (88-1203) vs. 6 (3-9) (rate ratio 49). Reduced eGFR and heavier albuminuria in kidney transplant recipients are associated with an increased risk of mortality and graft loss. Thus, eGFR and albuminuria may be used together to identify, evaluate, and manage transplant recipients who are at higher risk of adverse clinical outcomes.
2012 年，KDIGO 指南更新了慢性肾脏病的分类系统，纳入了白蛋白尿。该分类系统是否能预测肾移植受者的不良临床结局尚不清楚。为了评估这一点，我们使用加拿大阿尔伯塔省的关联数据库进行了一项回顾性研究，对 2002 年至 2011 年的肾移植受者进行随访。我们研究了一年时估算肾小球滤过率（eGFR 为 60 或以上、45-59、30-44、15-29ml/min/1.73m）和白蛋白尿（正常、轻度、重度）与随后的死亡率和移植物丢失之间的关系。共有 900 名有功能移植物的受者，在移植后一年至少有一次门诊血清肌酐和尿蛋白测量值。中位年龄为 51.2 岁，38.7%为女性，52%的 eGFR 为 60ml/min/1.73m 或以上。在 eGFR 降低或白蛋白尿较重的受者中，全因死亡率和死亡风险校正的移植物丢失风险增加。eGFR 为 15-29ml/min/1.73m 且白蛋白尿重度的受者与 eGFR 为 60ml/min/1.73m 或以上且蛋白正常排泄的受者相比，全因死亡率的校正发病率（每 1000 人年）为 117（95%可信区间 38-371）比 15（9-23）（率比 8）。死亡风险校正的移植物丢失率分别为 273（88-1203）比 6（3-9）（率比 49）。肾移植受者的 eGFR 降低和白蛋白尿增加与死亡率和移植物丢失风险增加相关。因此，eGFR 和白蛋白尿可一起用于识别、评估和管理有更高不良临床结局风险的移植受者。
