Kerschbaum Julia, Bitter Stefanie, Weitlaner Maria, Kienzl-Wagner Katrin, Neuwirt Hannes, Bösmüller Claudia, Mayer Gert, Schneeberger Stefan, Rudnicki Michael
Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
Department of Visceral, Transplant, and Thoracic Surgery, Medical University Innsbruck, 6020 Innsbruck, Austria.
J Clin Med. 2020 Jan 25;9(2):338. doi: 10.3390/jcm9020338.
Living kidney donation represents the optimal renal replacement therapy, but recent data suggest an increased long-term renal risk for the donor. Here, we evaluated the risk for reduced estimated glomerular filtration rate (eGFR), death, and major cardiovascular events such as nonfatal myocardial infarction or cerebrovascular event including TIA (transient ischemic attack) and stroke in 225 donors, who underwent pre-donation examinations and live donor nephrectomy between 1985 and 2014 at our center. The median follow-up time was 8.7 years (1.0-29.1). In multivariate analysis, age and arterial hypertension at baseline were significantly associated with a higher risk of adverse renal outcomes, such as (1) eGFR <60 mL/min/1.73 m (age per year: HR (hazard ratio) 1.05, 95% confidence interval (CI) 1.03-1.08, hypertension: HR 2.25, 95% CI 1.22-3.98), (2) eGFR <60 mL/min/1.73 m and a decrease of ≥40% from baseline (age: HR 1.08, 95% CI 1.03-1.13, hypertension: HR 4.22, 95% CI 1.72-10.36), and (3) eGFR <45 mL/min/1.73 m (age: HR 1.12, 95% CI 1.05-1.20, hypertension: HR 5.06, 95% CI 1.49-17.22). In addition, eGFR at time of donation (per mL/min/1.73 m) was associated with a lower risk of (1) eGFR <60 mL/min/1.73 m (HR 0.98, 95% CI 0.97-1.00) and (2) eGFR <45 mL/min/1.73 m (HR 0.95, 95% CI 0.90-1.00). Age was the only significant predictor for death or major cardiovascular event (HR 1.08, 95% CI 1.01-1.16). In conclusion, arterial hypertension, lower eGFR, and age at the time of donation are strong predictors for adverse renal outcomes in living kidney donors.
活体肾捐赠是最佳的肾脏替代治疗方法，但近期数据表明，捐赠者面临的长期肾脏风险有所增加。在此，我们评估了225名捐赠者的估计肾小球滤过率（eGFR）降低、死亡以及非致命性心肌梗死或包括短暂性脑缺血发作（TIA）和中风在内的脑血管事件等主要心血管事件的风险。这些捐赠者于1985年至2014年在我们中心接受了捐赠前检查和活体供肾切除术。中位随访时间为8.7年（1.0 - 29.1年）。在多变量分析中，基线时的年龄和动脉高血压与不良肾脏结局的较高风险显著相关，例如：（1）eGFR <60 mL/min/1.73 m²（年龄每年：风险比（HR）1.05，95%置信区间（CI）1.03 - 1.08，高血压：HR 2.25，95% CI 1.22 - 3.98），（2）eGFR <60 mL/min/1.73 m²且较基线下降≥40%（年龄：HR 1.08，95% CI 1.03 - 1.13，高血压：HR 4.22，95% CI 1.72 - 10.36），以及（3）eGFR <45 mL/min/1.73 m²（年龄：HR 1.12，95% CI 1.05 - 1.20，高血压：HR 5.06，95% CI 1.49 - 17.22）。此外，捐赠时的eGFR（每mL/min/1.73 m²）与以下情况的较低风险相关：（1）eGFR <60 mL/min/1.73 m²（HR 0.98，95% CI 0.97 - 1.00）和（2）eGFR <45 mL/min/1.73 m²（HR 0.95，95% CI 0.90 - 1.00）。年龄是死亡或主要心血管事件的唯一显著预测因素（HR 1.08，95% CI 1.01 - 1.16）。总之，动脉高血压、较低的eGFR以及捐赠时的年龄是活体肾捐赠者不良肾脏结局的有力预测因素。
