Al Jurdi Ayman, Safa Kassem
Division of Nephrology, Transplant Center, Massachusetts General Hospital, Boston, MA.
Transplant Direct. 2023 Mar 15;9(4):e1460. doi: 10.1097/TXD.0000000000001460. eCollection 2023 Apr.
New estimated glomerular filtration rate (GFR) equations that do not include a race coefficient have been created to better estimate kidney function, reduce inequities in kidney disease care, and improve the historically limited access to transplantation in African Americans. The impact of these new equations on estimated GFR (eGFR) in living donors pre- and postdonation is not known.
To address this, we conducted a single-center retrospective cohort study of 150 kidney donors and donor candidates. We calculated pre- and postdonation eGFR using the old and new equations and compared them with measured GFR by 2.8 mCi Tc-99m diethylene triamine penta-acetic acid clearance (mGFR) and 24-h creatinine clearance (mGFR). We evaluated the impact of the new equations on donation eligibility and postdonation eGFR.
We found that using the new eGFR equations resulted in higher predonation eGFR compared with the old equations but remained significantly lower than mGFR and mGFR. We also found that using the new eGFR equations would not exclude any potential donors based on our center's GFR criteria for donation. At 6 mo postdonation, the new equations resulted in higher eGFR values compared with the old equations.
The new eGFR equations continue to underestimate GFR in healthy donor candidates but would not exclude any potential donors from donation and resulted in higher eGFR predonation and postdonation in a predominantly White population. eGFR equations designed specifically for potential kidney donors are still needed for better kidney function assessment.
已创建了不包含种族系数的新的估计肾小球滤过率（GFR）方程，以更好地估计肾功能、减少肾病护理中的不公平现象，并改善非裔美国人历来有限的移植机会。这些新方程对活体供体捐献前后估计肾小球滤过率（eGFR）的影响尚不清楚。
为解决这一问题，我们对150名肾脏供体和供体候选人进行了单中心回顾性队列研究。我们使用新旧方程计算捐献前后的eGFR，并将其与通过2.8 mCi Tc-99m二乙三胺五乙酸清除率（mGFR）和24小时肌酐清除率（mGFR）测得的GFR进行比较。我们评估了新方程对捐献资格和捐献后eGFR的影响。
我们发现，与旧方程相比，使用新的eGFR方程导致捐献前eGFR更高，但仍显著低于mGFR和mGFR。我们还发现，根据我们中心的GFR捐献标准，使用新的eGFR方程不会排除任何潜在供体。在捐献后6个月，与旧方程相比，新方程得出的eGFR值更高。
新的eGFR方程在健康供体候选人中仍会低估GFR，但不会排除任何潜在供体参与捐献，并且在以白人为主的人群中导致更高的捐献前和捐献后eGFR。仍需要专门为潜在肾脏供体设计的eGFR方程，以更好地评估肾功能。
