Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
Transplantation. 2019 Jun;103(6):1216-1223. doi: 10.1097/TP.0000000000002411.
Living kidney donors have an increased risk of end-stage renal disease, with hypertension and diabetes as the predominant causes. In this study, we sought to better understand the timeline when these diseases occur, focusing on the early postdonation period.
We studied 41 260 living kidney donors in the United States between 2008 and 2014 from the Scientific Registry of Transplant Recipients and modeled incidence rates and risk factors for hypertension and diabetes.
At 6 months, 1 year, and 2 years postdonation, there were 74, 162, and 310 cases, respectively, of hypertension per 10 000 donors. Donors who were older (per 10 y, adjusted incidence rate ratio [aIRR], 1.40; 95% confidence interval [CI], 1.29-1.51), male (aIRR, 1.31; 95% CI, 1.14-1.50), had higher body mass index (per 5 units, aIRR, 1.29; 95% CI, 1.17-1.43), and were related to their recipient (first-degree relative: aIRR, 1.28; 95% CI, 1.08-1.52; spouse: aIRR, 1.34; 95% CI, 1.08-1.66) were more likely to develop hypertension, whereas donors who were Hispanic/Latino were less likely (aIRR, 0.71; 95% CI, 0.55-0.93). At 6 months, 1 year, and 2 years, there were 2, 6, and 15 cases of diabetes per 10 000 donors. Donors who were older (per 10 y: aIRR, 1.42; 95% CI, 1.11-1.82), had higher body mass index (per 5 units: aIRR, 1.52; 95% CI, 1.04-2.21), and were Hispanic/Latino (aIRR, 2.45; 95% CI, 1.14-5.26) were more likely to develop diabetes.
In this national study, new-onset diabetes was rare, but 3% of donors developed hypertension within 2 years of nephrectomy. These findings reaffirm that disease pathways for kidney failure differ by donor phenotype and estimate the population most at-risk for later kidney failure.
活体肾脏捐献者发生终末期肾病的风险增加，高血压和糖尿病是主要原因。在这项研究中，我们试图更好地了解这些疾病发生的时间线，重点关注捐赠后的早期阶段。
我们研究了 2008 年至 2014 年间美国科学移植受者登记处的 41260 名活体肾脏捐献者，并对高血压和糖尿病的发病率和危险因素进行了建模。
在捐赠后 6 个月、1 年和 2 年时，分别有 74、162 和 310 例高血压病例/每 10000 名供体。年龄较大（每 10 年，调整发病率比[aIRR]，1.40；95%置信区间[CI]，1.29-1.51）、男性（aIRR，1.31；95%CI，1.14-1.50）、体重指数较高（每增加 5 个单位，aIRR，1.29；95%CI，1.17-1.43）的供体以及与受者有关（一级亲属：aIRR，1.28；95%CI，1.08-1.52；配偶：aIRR，1.34；95%CI，1.08-1.66）的供体更有可能发生高血压，而西班牙裔/拉丁裔供体发生高血压的可能性较小（aIRR，0.71；95%CI，0.55-0.93）。在捐赠后 6 个月、1 年和 2 年时，每 10000 名供体中有 2、6 和 15 例糖尿病病例。年龄较大（每 10 年：aIRR，1.42；95%CI，1.11-1.82）、体重指数较高（每增加 5 个单位：aIRR，1.52；95%CI，1.04-2.21）以及西班牙裔/拉丁裔（aIRR，2.45；95%CI，1.14-5.26）的供体更有可能发生糖尿病。
在这项全国性研究中，新发糖尿病罕见，但 3%的供体在肾切除术 2 年内发生高血压。这些发现再次证实，导致肾衰竭的疾病途径因供体表型而异，并估计了发生晚期肾衰竭风险最高的人群。
