Seija M, Nin M, Santiago J, Apaza L, Castaño A, Poggi L, Urioste I, Chiossoni A, Fernandez A, Navarrine N, Garau M, Astesiano R, Ferrari M S, Noboa O
Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay; Departamento de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay.
Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay.
Transplant Proc. 2018 Dec;50(10):3392-3396. doi: 10.1016/j.transproceed.2018.04.040. Epub 2018 Apr 18.
Few studies have examined the relationship between non-immunological factors and glomerular filtration rate (GFR) decline in kidney transplant. Correcting these factors in native kidneys slows the progression of chronic kidney disease. The aim of this study was to analyze the association between the control of non-immunological factors and the annual decline of GFR.
A single-center, retrospective study was performed. We included 128 patients who received kidney transplants between 2000 and 2015, with at least 1-year post-transplant follow-up. Clinical records were reviewed. GFR was estimated by CKD-EPI. Three groups were defined according to the annual change in eGFR (ΔGFR 2016-1015): non-progressors (> -1 mL/min/1.73 m), slow progressors (> -1 and < -5 mL/min/1.73 m), and fast progressors (< -5 mL/min/1.73 m). Percentage of achievement of KDIGO target was also analyzed.
The mean GFR was 62.5 mL/min/1.73 m. Glomerulonephritis was the most common cause of kidney failure (36%). When the fast progressor group was compared with the non-progressor group, they differed significantly in age-patients were younger (40 ± 12.3 vs 45 ± 13.1 years)-post-transplant body mass index (27.4 ± 5.6 vs 25.2 x ± 5.9 kg/m), and serum uric acid, which was significantly higher (6.4 ± 1.7 vs 5.5 ± 1.58 mg/dL). There were no differences between the groups with regard to blood pressure, dyslipidemia, proteinuria, or venous bicarbonate. Target systolic blood pressure was achieved by 45% of patients. Biopsy-proven acute rejection was higher in the fast progression group, although this was not statistically significant (13 [24.5%] vs 8 [13.1%]).
High body mass index was associated with a faster decline in glomerular filtration rate in this study. Target blood pressure <140/90 mm Hg was achieved in less than 50% of cases.
很少有研究探讨肾移植中非免疫因素与肾小球滤过率（GFR）下降之间的关系。纠正天然肾脏中的这些因素可减缓慢性肾脏病的进展。本研究的目的是分析非免疫因素的控制与GFR年度下降之间的关联。
进行了一项单中心回顾性研究。我们纳入了2000年至2015年间接受肾移植且移植后至少随访1年的128例患者。对临床记录进行了回顾。GFR通过CKD-EPI估算。根据估算的肾小球滤过率（eGFR）的年度变化（ΔGFR 2016 - 2015）定义了三组：非进展者（> -1 mL/min/1.73 m²）、缓慢进展者（> -1且< -5 mL/min/1.73 m²）和快速进展者（< -5 mL/min/1.73 m²）。还分析了达到KDIGO目标的百分比。
平均GFR为62.5 mL/min/1.73 m²。肾小球肾炎是肾衰竭最常见的原因（36%）。将快速进展组与非进展组进行比较时，他们在年龄（患者更年轻，40 ± 12.3岁对45 ± 13.1岁）、移植后体重指数（27.4 ± 5.6对25.2 ± 5.9 kg/m²）和血清尿酸方面存在显著差异，血清尿酸显著更高（6.4 ± 1.7对5.5 ± 1.58 mg/dL）。各组在血压、血脂异常、蛋白尿或静脉血碳酸氢盐方面无差异。45%的患者达到了目标收缩压。快速进展组活检证实的急性排斥反应更高，尽管这无统计学意义（13例[24.5%]对8例[13.1%]）。
在本研究中，高体重指数与肾小球滤过率更快下降相关。不到50%的病例达到了目标血压<140/90 mmHg。
