Dhalla Anisha, Ravani Pietro, Quinn Robert R, Garg Amit X, Clarke Alix, Al-Wahsh Huda, Lentine Krista L, Klarenbach Scott, Hemmelgarn Brenda R, Wang Carol, Lam Ngan N
Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada.
Department of Medicine, Division of Nephrology, Western University, London, ON, Canada.
Kidney Med. 2023 Dec 4;6(2):100767. doi: 10.1016/j.xkme.2023.100767. eCollection 2024 Feb.
RATIONALE & OBJECTIVE: Chronic kidney disease is associated with significant morbidity and mortality in the general population, but little is known about the incidence and risk factors associated with developing low estimated glomerular filtration rate (eGFR) and moderate-severe albuminuria in living kidney donors following nephrectomy.
Retrospective, population-based cohort study.
SETTING & PARTICIPANTS: Kidney donors in Alberta, Canada.
Donor nephrectomy between May 2001 and December 2017.
Two eGFR measurements <45 mL/min/1.73 m or 2 measurements of moderate or severe albuminuria from 1-year postdonation onwards that were at least 90 days apart.
Associations between potential risk factors and the primary outcome were assessed using Cox proportional hazard regression analyses.
Over a median follow-up period of 8.6 years (IQR, 4.7-12.6 years), 47 of 590 donors (8.0%) developed sustained low eGFR or moderate-severe albuminuria with an incidence rate of 9.2 per 1,000 person-years (95% confidence interval, 6.6-11.8). The median time for development of this outcome beyond the first year after nephrectomy was 2.9 years (IQR, 1.4-8.0 years). Within the first 4 years of follow-up, a 5 mL/min/1.73 m lower predonation eGFR increased the hazard of developing postdonation low eGFR or moderate-severe albuminuria by 26% (adjusted HR, 1.26; 95% CI, 1.10-1.44). Furthermore, donors were at higher risk of developing low eGFR or albuminuria if they had evidence of predonation hypertension (adjusted HR, 2.52; 95% CI, 1.28-4.96) or postdonation diabetes (adjusted HR, 4.72; 95% CI, 1.54-14.50).
We lacked data on certain donor characteristics that may affect long-term kidney function, such as race, smoking history, and transplant-related characteristics.
A proportion of kidney donors at an incidence rate of 9.2 per 1,000 person-years will develop low eGFR or albuminuria after donation. Donors with lower predonation eGFR, predonation hypertension, and postdonation diabetes are at increased risk of developing this outcome.
慢性肾脏病与普通人群的高发病率和死亡率相关，但对于肾切除术后活体肾供者发生低估算肾小球滤过率（eGFR）和中重度蛋白尿的发病率及危险因素知之甚少。
基于人群的回顾性队列研究。
加拿大艾伯塔省的肾供者。
2001年5月至2017年12月期间进行的供肾切除术。
两次eGFR测量值<45 mL/min/1.73 m²，或自捐献后1年起两次中重度蛋白尿测量值，且两次测量间隔至少90天。
使用Cox比例风险回归分析评估潜在危险因素与主要观察指标之间的关联。
在中位随访期8.6年（四分位间距，4.7 - 12.6年）内，590名供者中有47名（8.0%）出现持续性低eGFR或中重度蛋白尿，发病率为每1000人年9.2例（95%置信区间，6.6 - 11.8）。肾切除术后第一年之后出现该观察指标的中位时间为2.9年（四分位间距，1.4 - 8.0年）。在随访的前4年内，捐献前eGFR每降低5 mL/min/1.73 m²，捐献后发生低eGFR或中重度蛋白尿的风险增加26%（校正风险比，1.26；95%置信区间，1.10 - 1.44）。此外，如果供者有捐献前高血压证据（校正风险比，2.52；95%置信区间，1.28 - 4.96）或捐献后糖尿病证据（校正风险比，4.72；95%置信区间，1.54 - 14.50），则发生低eGFR或蛋白尿的风险更高。
我们缺乏某些可能影响长期肾功能的供者特征数据，如种族、吸烟史和移植相关特征。
肾供者中有一定比例（发病率为每1000人年9.2例）在捐献后会出现低eGFR或蛋白尿。捐献前eGFR较低、捐献前高血压和捐献后糖尿病的供者发生此结局的风险增加。
