Lee Darren, Manzoor Momena, Harley Geoff, Whitlam John, Cook Natasha, Choy Suet-Wan, Sandiford Megan, Gibson Charlotte, McMahon Lawrence P, Roberts Matthew A
Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
Department of Renal Medicine, Eastern Health, Melbourne, Victoria, Australia.
Nephrology (Carlton). 2018 Jul;23(7):616-624. doi: 10.1111/nep.13074.
The Kidney Disease Improving Global Outcomes (KDIGO) guideline recommends the incorporation of a new risk calculator that quantifies the end-stage kidney disease (ESKD) risk based on a composite profile of risk factors in living kidney donor candidates (LKDC). We compared the ESKD risk estimates in previously declined versus accepted LKDC to evaluate the predictive capacity and potential impact of this tool.
Baseline 15 year and lifetime ESKD risk estimates without donation were calculated using the risk calculator for LKDC assessed from two centres between 2007 and 2015. LKDC suitability based on the proposed KDIGO and the existing Caring for Australasians with Renal Impairment national guidelines was compared.
Median 15 year ESKD risk was 0.14% (IQR 0.09-0.31%) in declined LKDC (n=59) versus 0.10% (0.07-0.14%) in accepted LKDC (n=89) (P<0.001). Lifetime risk was similar: 0.39% (0.23-0.80%) versus 0.35% (0.22-0.56%), respectively; however, declined LKDC had a higher 98% risk percentile value (8.19% vs 1.02%) and were more likely to exceed a 1% ESKD risk threshold (15% vs 1%; P<0.01). The calculator captured reasons for declining donation in only 39% of LKDC; 46.9% of LKDC with Caring for Australasians with Renal Impairment contraindications were reclassified as having an acceptable (≤1%) lifetime risk and no KDIGO contraindications, primarily related to a lower pre-donation glomerular filtration rate or controlled hypertension with obesity.
Declined LKDC had a higher 15 year but similar lifetime ESKD risk. However, the calculator successfully differentiated declined LKDC with a lifetime risk >1%. This risk calculator appears to complement but not replace clinical evaluation.
改善全球肾脏病预后组织（KDIGO）指南建议采用一种新的风险计算器，该计算器根据活体肾供体候选人（LKDC）的综合风险因素概况来量化终末期肾病（ESKD）风险。我们比较了之前被拒绝与被接受的LKDC的ESKD风险估计值，以评估该工具的预测能力和潜在影响。
使用2007年至2015年期间从两个中心评估的LKDC风险计算器，计算无捐赠情况下的基线15年和终身ESKD风险估计值。比较了基于拟议的KDIGO和现有的《关爱澳大利亚肾脏疾病患者》国家指南的LKDC适用性。
被拒绝的LKDC（n = 59）的15年ESKD风险中位数为0.14%（四分位间距0.09 - 0.31%），而被接受的LKDC（n = 89）为0.10%（0.07 - 0.14%）（P < 0.001）。终身风险相似：分别为0.39%（0.23 - 0.80%）和0.35%（0.22 - 0.56%）；然而，被拒绝的LKDC的98%风险百分位数更高（8.19%对1.02%），并且更有可能超过1%的ESKD风险阈值（15%对1%；P < 0.01）。该计算器仅在39%的LKDC中捕捉到了拒绝捐赠的原因；46.9%有《关爱澳大利亚肾脏疾病患者》禁忌症的LKDC被重新分类为具有可接受的（≤1%）终身风险且无KDIGO禁忌症，主要与捐赠前较低的肾小球滤过率或伴有肥胖的控制良好的高血压有关。
被拒绝的LKDC有较高的15年ESKD风险，但终身ESKD风险相似。然而，该计算器成功区分了终身风险>1%的被拒绝的LKDC。这种风险计算器似乎是对临床评估的补充，而非替代。
