肺移植患者肾功能的评估

Evaluation of Renal Function in Patients Undergoing Lung Transplantation.

作者信息

Carillo C, Pecoraro Y, Anile M, Mantovani S, Oliva A, D'Abramo A, Amore D, Pagini A, De Giacomo T, Pugliese F, Rendina E A, Venuta F, Diso D

机构信息

Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.

出版信息

Transplant Proc. 2017 May;49(4):699-701. doi: 10.1016/j.transproceed.2017.02.036.

DOI:10.1016/j.transproceed.2017.02.036

PMID:28457375

Abstract

BACKGROUND

Acute kidney injury and chronic kidney failure are serious complications after lung transplantation. Glomerular filtration rate (GFR) is the primary indicator of renal function. Several equations have been proposed to evaluate the estimated GFR (eGFR). We compared three different equations to determine which has the better correlation with the development of acute and chronic renal failure in lung recipients.

METHODS

Twenty-two patients with a mean age of 54.4 ± 8.5 years underwent lung transplantation from 2010 to 2015. Thirteen (59%) had pulmonary fibrosis, 7 (32%) emphysema, 1 (4.5%) bronchiectasis, and 1 (4.5%) lymphangioleiomyomatosis. In all patients, eGFR was measured preoperatively using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Levey's Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. In 20 patients (90%) eGFR was calculated at 1, 3, and 6 months.

RESULTS

According to CKD-EPI and MDRD, eight patients (36.3%) had preoperative reduction in eGFR, whereas 6 patients (27.2%) had preoperative reduction according to the CG (P = .04). The mean values were higher for the CG (103.2 vs. 102 vs. 94.4). Five patients (22.7%) developed perioperative acute renal failure requesting a dialysis treatment; four of these showed a preoperative eGFR to the highest CG (P = .05). At 1 and 6 months after lung transplantation, the CG, MDRD and CKD-EPI eGFR values were, respectively, 86.6, 84.1 and 76.6 mL/min/1.73m and 75.8, 72.7, and 72.3 mL/min/1.73m. CKD-EPI eGFR values are more predictable than the other equations of AKI.

CONCLUSIONS

Preoperative assessment of eGFR using the MDRD and CKD-EPI seems to correlate better than the CG to the prediction of acute renal failure, whereas for the chronic form the three equations seem equivalent.

摘要

背景

急性肾损伤和慢性肾衰竭是肺移植术后的严重并发症。肾小球滤过率（GFR）是肾功能的主要指标。已经提出了几种方程来评估估算的GFR（eGFR）。我们比较了三种不同的方程，以确定哪一种与肺移植受者急性和慢性肾衰竭的发生具有更好的相关性。

方法

2010年至2015年期间，22例平均年龄为54.4±8.5岁的患者接受了肺移植。其中13例（59%）患有肺纤维化，7例（32%）患有肺气肿，1例（4.5%）患有支气管扩张，1例（4.5%）患有淋巴管平滑肌瘤病。所有患者术前均使用Cockcroft-Gault（CG）方程、肾脏病饮食改良（MDRD）方程和Levey的慢性肾脏病流行病学协作组（CKD-EPI）方程测量eGFR。20例（90%）患者在术后1、３和6个月计算eGFR。

结果

根据CKD-EPI和MDRD方程，8例患者（36.3%）术前eGFR降低，而根据CG方程有6例患者（27.2%）术前eGFR降低（P = 0.04）。CG方程的平均值更高（103.2对102对94.4）。5例患者（22.7%）发生围手术期急性肾衰竭，需要进行透析治疗；其中4例术前eGFR为最高的CG值（P = 0.05）。肺移植术后1个月和6个月时，CG、MDRD和CKD-EPI的eGFR值分别为86.6、84.1和76.6 mL/min/1.73m²以及75.8、72.7和72.3 mL/min/1.73m²。CKD-EPI的eGFR值比其他评估急性肾损伤的方程更具预测性。