评估基于术前腹部脂肪组织、炎症、肌肉量和营养状况的预后标志物以评估活体肾供体的肾功能障碍

Evaluation of Preoperative Abdominal Adipose Tissue-, Inflammation-, Muscle Mass-, and Nutritional Status-based Prognostic Markers to Assess Renal Dysfunction in Living Kidney Donors.

作者信息

Hori Shunta, Morizawa Yosuke, Gotoh Daisuke, Itami Yoshitaka, Nakai Yasushi, Miyake Makito, Anai Satoshi, Torimoto Kazumasa, Aoki Katsuya, Yoneda Tatsuo, Tanaka Nobumichi, Yoshida Katsunori, Fujimoto Kiyohide

机构信息

Department of Urology, Nara Medical University, Kashihara, Japan.

出版信息

Transplant Proc. 2019 Jul-Aug;51(6):1706-1716. doi: 10.1016/j.transproceed.2019.04.057.

DOI:10.1016/j.transproceed.2019.04.057

PMID:31399161

Abstract

BACKGROUND

Living kidney donors (LKDs) are at high risk of renal dysfunction after undergoing a donor nephrectomy (DN), resulting in poor prognosis associated with the development of cardiovascular or cerebrovascular disease. Decreasing this risk can improve the survival rate of LKDs. We investigated the effects of preoperative conditions in LKDs on renal dysfunction after DN using abdominal adipose tissue, inflammation, nutritional status, and muscle mass as markers for this assessment.

METHODS

Our retrospective study included 79 LKDs. Body composition markers were assessed using preoperative unenhanced computed tomographic images. Inflammation- and nutritional status-based markers were assessed using preoperative laboratory blood tests. The association between each marker was investigated, and prognostic markers for renal dysfunction after DN were identified.

RESULTS

The LKDs in this cohort comprised 30 men and 49 women. The median age at the time of DN and the preoperative estimated glomerular filtration rate were 58 years and 81.9 mL/min/1.73 m, respectively. Abdominal subcutaneous adipose tissue and muscle mass significantly differed between the sexes. Each adipose tissue-, inflammation-, nutritional status-, and muscle mass-based marker showed an association with each other. Abdominal visceral adipose tissue and nutritional status could be independent prognostic markers for renal dysfunction after DN.

CONCLUSIONS

Our findings suggest that the preoperative condition of LKDs (assessed using specific markers such as abdominal visceral adipose tissue mass per volume and nutritional status) could affect renal dysfunction after DN. Optimal preoperative management can lead to better outcomes in LKDs. Further research is needed to establish appropriate exercise programs and nutritional interventions.

摘要

背景

活体肾供体（LKDs）在接受供肾切除术后发生肾功能不全的风险很高，这会导致与心血管或脑血管疾病发展相关的预后不良。降低这种风险可以提高LKDs的生存率。我们使用腹部脂肪组织、炎症、营养状况和肌肉量作为评估指标，研究了LKDs术前状况对供肾切除术后肾功能不全的影响。

方法

我们的回顾性研究纳入了79名LKDs。使用术前未增强的计算机断层扫描图像评估身体成分指标。使用术前实验室血液检查评估基于炎症和营养状况的指标。研究了每个指标之间的关联，并确定了供肾切除术后肾功能不全的预后指标。

结果

该队列中的LKDs包括30名男性和49名女性。供肾切除时的中位年龄和术前估计肾小球滤过率分别为58岁和81.9 mL/min/1.73 m²。腹部皮下脂肪组织和肌肉量在性别之间存在显著差异。每个基于脂肪组织、炎症、营养状况和肌肉量的指标之间都显示出关联。腹部内脏脂肪组织和营养状况可能是供肾切除术后肾功能不全的独立预后指标。