Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Am J Nephrol. 2018;47(3):191-199. doi: 10.1159/000487714. Epub 2018 Mar 14.
Several studies have been performed to evaluate surrogate markers of long-term allograft function in renal transplant recipients. These include serum creatinine, estimated glomerular filtration rate (eGFR), slope of eGFR, and more recently eGFR variability. The aim of this study was to measure eGFR slope while assessing the variability of this slope and if high variability occurring at any time post-transplant was predictive of poorer long-term outcomes in a large cohort of kidney transplant recipients.
Adult solitary kidney transplant recipients transplanted between July 1, 2005 and July 31, 2015 were included. The primary outcome was time to graft loss, defined as return to chronic dialysis, retransplant, or death. Secondary outcomes were death-censored graft loss and acute allograft rejection. Cox regression was utilized for primary and secondary outcomes. Multivariate logistic regression was used to determine baseline factors predictive of high eGFR variability.
A total of 1,543 patients were included in the analysis. The percentage of patients who experienced an eGFR coefficient of variation of <30% was 79.6% (1,229/1,543), while 20.4% (314/1,543) patients had high eGFR variability (≥30%). Patients with high eGFR variability tended to be younger, African-American and female. Those with higher eGFR variability, accounting for confounding and other eGFR measures (peak and slope), had significantly lower overall patient and graft survival.
This study provides a novel analysis of the utility of eGFR variability in a large cohort. The clinical use of the slope of eGFR and eGFR variability may aid in predicting long-term graft outcomes and facilitate early patient discussions to change the trajectory of allograft function.
多项研究已经评估了肾移植受者长期移植物功能的替代标志物。这些标志物包括血清肌酐、估计肾小球滤过率（eGFR）、eGFR 斜率，以及最近的 eGFR 变异性。本研究的目的是测量 eGFR 斜率，同时评估斜率的变异性，以及移植后任何时间的高变异性是否可预测大量肾移植受者的长期预后较差。
纳入 2005 年 7 月 1 日至 2015 年 7 月 31 日期间接受单肾移植的成年受者。主要结局是移植物丢失时间，定义为返回慢性透析、再次移植或死亡。次要结局是死亡相关移植物丢失和急性移植物排斥。采用 Cox 回归分析主要和次要结局。采用多变量逻辑回归确定预测高 eGFR 变异性的基线因素。
共纳入 1543 例患者进行分析。eGFR 变异系数<30%的患者比例为 79.6%（1229/1543），而 eGFR 变异性高（≥30%）的患者比例为 20.4%（314/1543）。eGFR 变异性高的患者倾向于更年轻、非裔美国人且为女性。与 eGFR 变异性较高的患者相比，整体患者和移植物存活率较低。
本研究对 eGFR 变异性在大型队列中的应用进行了新的分析。eGFR 斜率和 eGFR 变异性的临床应用可能有助于预测长期移植物结局，并促进早期患者讨论，改变移植物功能的轨迹。
