Vinodh Gerard, Dheerendra Prashant C, Anitha Aleya, Anandkumar Deepashree Goravigere, Vellakampadi Deepesh
Deaprtment of Nephrology, Karpagam Faculty of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
Department of Nephrology, Apollo Hospitals, Bangalore, Karnataka, India.
Indian J Nephrol. 2024 Sep-Oct;34(5):487-492. doi: 10.25259/ijn_417_23. Epub 2024 Jun 4.
Technetium-99 diethylene-triamine-pentaacetate (99Tc-DTPA)-based scintigraphy is a convenient way to assess measured glomerular filtration rate (mGFR) in kidney donors. Equations have been developed to calculate GFR in the general population. This study aims to identify the best among commonly employed equations to better predict GFR when compared with scintigraphy-based mGFR. Also, the trends in mGFR values were studied over 1 year post-donation.
Thirty-four kidney donors were recruited for this study from November 2017 to November 2018 and followed-up for a year. Estimated GFR (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) Equation, Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration equation, and Nankivell formula; the values were compared to that obtained using 99Tc-DTPA both pre-and post-donation. Correlation and agreement between the eGFR and mGFR were studied using Statistical Package for the Social Sciences (SPSS) version 23.0 and Microsoft Excel.
mGFR was augmented by 32.3 ± 27.8% in the remnant kidney post-donation. The baseline mGFR, post-donation mGFR, and the quantum of its increase post-donation did not differ between overweight donors and donors with normal body mass index (BMI). mGFR correlated poorly with all the eGFR equations both pre- and post-donation. Bland-Altman analysis showed weak agreement with significant bias and variance between mGFR and all eGFR equations.
In Indian kidney donors, mGFR by 99Tc-DTPA scintigraphy shows poor correlation and agreement with the commonly used eGFR equations. An individualized approach is needed to assess the kidney function of live donors to minimize harm to both the recipient and the donor.
基于锝-99二乙三胺五乙酸（99Tc-DTPA）的闪烁扫描术是评估肾供体中测量的肾小球滤过率（mGFR）的便捷方法。已开发出用于计算普通人群肾小球滤过率的公式。本研究旨在确定常用公式中与基于闪烁扫描术的mGFR相比能更好预测肾小球滤过率的最佳公式。此外，还研究了捐献后1年内mGFR值的变化趋势。
2017年11月至2018年11月招募了34名肾供体进行本研究，并随访1年。使用肾脏病饮食改良（MDRD）公式、慢性肾脏病流行病学（CKD-EPI）协作公式和南基韦尔公式计算估计肾小球滤过率（eGFR）；将这些值与捐献前后使用99Tc-DTPA获得的值进行比较。使用社会科学统计软件包（SPSS）23.0版和Microsoft Excel研究eGFR与mGFR之间的相关性和一致性。
捐献后残余肾的mGFR增加了32.3±27.8%。超重供体与体重指数（BMI）正常的供体之间，基线mGFR、捐献后mGFR及其捐献后增加量无差异。捐献前后mGFR与所有eGFR公式的相关性均较差。Bland-Altman分析显示mGFR与所有eGFR公式之间一致性较弱，存在显著偏差和方差。
在印度肾供体中，99Tc-DTPA闪烁扫描术测得的mGFR与常用的eGFR公式之间的相关性和一致性较差。需要采用个体化方法评估活体供体的肾功能，以尽量减少对受者和供体的伤害。
