Tantiyavarong Pichaya, Kramer Anneke, Heaf James G, Finne Patrik, Åsberg Anders, Cases Aleix, Caskey Fergus J, Massy Ziad A, Jager Kitty J, Noordzij Marlies
Division of Clinical Epidemiology, Thammasat University, Pathum Thani, Thailand.
Nephrology Division, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
Clin Kidney J. 2019 Jul 1;13(2):188-198. doi: 10.1093/ckj/sfz062. eCollection 2020 Apr.
Kidney transplantation should improve abnormalities that are common during dialysis treatment, like anaemia and mineral and bone disorder. However, its impact is incompletely understood. We therefore aimed to assess changes in clinical indicators after the transition from chronic dialysis to kidney transplantation.
We used European Renal Association-European Dialysis and Transplant Association Registry data and included adult dialysis patients for whom data on clinical indicators before and after transplantation (2005-15) were available. Linear mixed models were used to quantify the effect of transplantation and of time after transplantation for each indicator.
In total, 16 312 patients were included. The mean age at transplantation was 50.1 (standard deviation 14.2) years, 62.9% were male and 70.2% were on haemodialysis before transplantation. Total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and triglycerides increased right after transplantation but decreased thereafter. All other indicators normalized or approached the target range soon after transplantation and these improvements were sustained for the first 4 years of follow-up. In patients with higher estimated glomerular filtration rate (eGFR) levels (30-60 and >60 mL/min/1.73 m), the improvement of haemoglobin, ferritin, ionized calcium, phosphate, parathyroid hormone, HDL cholesterol, triglycerides, albumin and C-reactive protein levels was more pronounced than in patients with a lower eGFR (<30 mL/min/1.73 m).
Except for total cholesterol, LDL cholesterol and triglycerides, all clinical indicators improved after transplantation. These improvements were related to eGFR. Nevertheless, values remained out of range in a considerable proportion of patients and anaemia and hyperparathyroidism were still common problems. Further research is needed to understand the complex relationship between eGFR and the different clinical indicators.
肾移植应能改善透析治疗期间常见的异常情况，如贫血以及矿物质和骨代谢紊乱。然而，其影响尚未完全明确。因此，我们旨在评估从慢性透析过渡到肾移植后临床指标的变化。
我们使用了欧洲肾脏协会 - 欧洲透析和移植协会登记数据，纳入了有移植前后（2005 - 2015年）临床指标数据的成年透析患者。采用线性混合模型来量化移植以及移植后时间对每个指标的影响。
总共纳入了16312例患者。移植时的平均年龄为50.1（标准差14.2）岁，62.9%为男性，70.2%在移植前接受血液透析。总胆固醇、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）胆固醇以及甘油三酯在移植后立即升高，但随后下降。所有其他指标在移植后不久即恢复正常或接近目标范围，并且这些改善在随访的前4年中持续存在。在估计肾小球滤过率（eGFR）水平较高（30 - 60和>60 mL/min/1.73 m²）的患者中，血红蛋白、铁蛋白、离子钙、磷酸盐、甲状旁腺激素、HDL胆固醇、甘油三酯、白蛋白和C反应蛋白水平的改善比eGFR较低（<30 mL/min/1.73 m²）的患者更为明显。
除总胆固醇、LDL胆固醇和甘油三酯外，移植后所有临床指标均有改善。这些改善与eGFR有关。然而，相当一部分患者的值仍超出范围，贫血和甲状旁腺功能亢进仍然是常见问题。需要进一步研究以了解eGFR与不同临床指标之间的复杂关系。
