Division of Nephrology and Kidney Center, Graduate School of Medicine, Kobe University, Kobe, Japan.
Nephron. 2023;147 Suppl 1:61-66. doi: 10.1159/000531915. Epub 2023 Aug 23.
Because of the lack of organ donation, living kidney transplantation (LKT) is increasing worldwide. Recently, the number of elderly donors has been increasing, and the patients with end-stage kidney diseases are older than those in the previous decades. Due to the advanced ages, their glomerular filtration rates (GFR) decrease, and the comorbidities such as hypertension, diabetic condition, and obesity are common. The clinicians now have to give their unwilling consent to the LKT from the donors with expanded criteria.
For the secure selection of donors, proper GFR measuring is essential. Although directly measured GFR (mGFR) was recommended in the guidelines, estimated GFR (eGFR) is used at the initial evaluation of donor renal function clinically. Many equations calculating eGFR have been published so far. In the selection of eGFR equations, the smaller difference between mGFR and eGFR and the closer relationship to the prevalence rates of comorbidities are requisite points. Therefore, we compared the specificity of the various eGFR equations. The eGFR calculated from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation showed approximate reliability with minimal difference between mGFR and eGFR and the closer relationships to the prevalence rates of comorbidities.
The CKD-EPI-eGFR presented optimal performance in the donor renal function evaluation. Therefore, eGFR from the CKD-EPI equation is highly recommended in evaluating renal function in LKT donors.
由于器官捐献的缺乏，活体肾移植（LKT）在全球范围内不断增加。最近，老年供体的数量有所增加，而终末期肾病患者比前几十年的患者年龄更大。由于年龄较大，他们的肾小球滤过率（GFR）下降，高血压、糖尿病和肥胖等合并症也很常见。临床医生现在不得不对符合扩展标准的供体进行不情愿的 LKT 手术。
为了安全选择供体，适当的 GFR 测量至关重要。虽然指南推荐直接测量 GFR（mGFR），但在临床评估供体肾功能的初始阶段，通常使用估算的 GFR（eGFR）。迄今为止，已经发表了许多计算 eGFR 的方程。在选择 eGFR 方程时，mGFR 和 eGFR 之间的差异越小，与合并症的患病率的关系越密切，是必要的。因此，我们比较了各种 eGFR 方程的特异性。来自慢性肾脏病流行病学合作（CKD-EPI）方程的 eGFR 显示出近似可靠性，mGFR 和 eGFR 之间的差异最小，与合并症的患病率的关系更密切。
CKD-EPI-eGFR 在供体肾功能评估中表现出最佳性能。因此，在评估 LKT 供体的肾功能时，强烈推荐使用 CKD-EPI 方程计算的 eGFR。
