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1.
I. Godinho J. Guerra M.J. Melo M. Neves J. Gonçalves M.A. Santana A. Gomes da Costa 《Transplantation proceedings》2018,50(3):719-722
Background
With the rising prevalence of living-donor kidney transplantation, evaluation of factors correlated with renal function in the donor-recipient pair constitutes a main goal for kidney transplantation clinicians. Our objective was to analyze the more relevant donor characteristics that contribute to donor and recipient estimated glomerular filtration rates (eGFR) after 1 year.Methods
We evaluated 48 consecutive donor-recipient pairs from our unit.Results
Mean donor age was 46 ± 11 years, with 71% being women. Mean recipient age was 35 ± 12 years, with 54% being men. Mean duration of donor hospitalization was 7 ± 2 days. Donor eGFR was 104 ± 11 mL/min/1.73 m2 before donation and 70 ± 14 mL/min/1.73 m2 at discharge. After 1 year, donor eGFR was 71 ± 12 mL/min/1.73 m2 and recipient eGFR was 69 ± 10 mL/min/1.73 m2. Donor eGFR <100 mL/min/1.73 m2 before donation and age >50 years correlated with 17.7- and 8.9-fold increased risks, respectively, of recipient eGFR <60 mL/min/1.73 m2 after 1 year. Donor being female, although statistically associated with worse graft function, compared with a male donor (P = .020), did not represent a significantly increased risk of recipient eGFR <60 mL/min/1.73 m2. Higher donor body mass index (BMI) also associated with a lower kidney function for donors (P = .048). In multivariate linear regression to predict pairs' eGFRs after 1 year, only donor eGFR before donation and at discharge retained statistical significance (P ≤ .001 and P = .045, respectively).Conclusions
Excluding unpredictable complications in the post-transplantation period, donor eGFR before donation, eGFR at discharge, and age were the best parameters to predict recipient and donor eGFRs after 1 year and can be used as a tool for managing expectations regarding the post-transplantation period. 相似文献2.
Background
Hyperuricemia has been associated with kidney disease and remains controversial with regard to its gender-specific differences and impact in living kidney donation.Methods
Between 2006 and 2015, charts of live kidney donors who underwent nephrectomy and had a minimum follow-up of 1 year were reviewed. A total of 291 donors were included and divided based on gender-specific pre-donation serum uric acid (SUA) tertiles. Renal functional outcomes included were estimated glomerular filtration rate (eGFR) at 6-month and 1-year follow-up and percentage of donors with a 1-year eGFR <60 mL/min/1.72 m2. Logistic regression analysis was done.Results
Mean SUA tertiles were 5.8 ± 1.1 mg/dL in males and 4.1 ± 1 mg/dL in females. Females in the highest tertile (SUA >4.5 mg/dL) had lower 6-month (59.9 ± 10.3 vs 66.9 ± 14.1 vs 67.3 ± 12.1; P = .018) and 1-year (60.8 ± 10.6 vs 67.6 ± 10.8 vs 67.8 ± 11.8; P = .021) eGFR and a higher percentage of donors with 1-year eGFR <60 mL/min/1.73 m2 (59.5% vs 31.6% vs 23%; P = .002) compared with donors in the lower SUA tertiles (≤4.5 mg/dL). In males, there were similar eGFRs among SUA tertiles at 6-month and 1-year follow-up. In multivariate analysis, SUA was shown to be a significant predictor of developing stage 3 CKD (eGFR <60 mL/min/1.72 m2), 1 year after donation in females but not in males.Conclusions
Predonation SUA level is associated with the development of delayed renal recovery (GFR <60 mL/min/1.72 m2) 1 year after donation in females but not in males. 相似文献3.
Byron?H.?Lee Emily?C.?Zabor Daniel?Tennenbaum Helena?Furberg Nicole?Benfante Jonathan?A.?Coleman Edgar?A.?Jaimes Paul?Russo
Purpose
To understand the longitudinal renal function trends in patients undergoing radical nephroureterectomy (RNU) and identify clinicopathologic characteristics associated with estimated glomerular filtration rate (eGFR) recovery.Methods
147 patients were available for analysis. Longitudinal eGFR trends were assessed by plotting each patient’s eGFR measurements over time. The patient population was dichotomized using eGFR < 60 ml/min/1.73 m2 versus ≥ 60 ml/min/1.73 m2. Cumulative incidence and competing risk regression analysis were used to estimate recovery of postoperative eGFR to the preoperative level and identify clinicopathologic characteristics associated with eGFR recovery.Results
Median age was 68.7 years and median preoperative eGFR was 55.9 ml/min/1.73 m2. 63.6% were male and 95.8% were white. The cumulative incidence of eGFR recovery was significantly higher in patients with baseline eGFR < 60 ml/min/1.73 m2 compared to those with baseline eGFR ≥ 60 ml/min/1.73 m2 (p = 0.01), with recovery rates at 2 years of 56.6% vs. 27.7%, respectively. Multivariable analysis revealed that preoperative hydronephrosis (HR 1.80) and preoperative eGFR < 60 ml/min/1.73 m2 (HR 1.87) were associated with increased chance of eGFR recovery.Conclusion
Over half of patients with preoperative eGFR < 60 ml/min/1.73 m2 achieved eGFR recovery within the first 3 years after RNU, and hydronephrosis was a significant predictor of recovery. These findings should be considered when counseling patients regarding chronic kidney disease progression after RNU and timing of perioperative chemotherapy for high risk tumors.4.
Masayuki Sugimoto Noriko Takahashi Kiyoaki Niimi Akio Kodama Hiroshi Banno Kimihiro Komori 《Journal of vascular surgery》2018,67(4):1042-1050
Background
Although the indications for endovascular aneurysm repair for abdominal aortic aneurysm have been expanding, our primary strategy for pararenal and juxtarenal abdominal aortic aneurysm (P/JRAA) is open surgery (OS). One consequence of OS for P/JRAA is transient renal ischemia owing to renal artery clamping, which can be followed by acute kidney injury (AKI). Prior studies referred to the impact of renal ischemia on AKI, but they have rarely evaluated longer-term renal function. This study focused on a chronic renal decline (CRD) during follow-up.Methods
A retrospective review of our series of P/JRAA treated with OS from 2007 to 2015. Patients on hemodialysis at the time of surgery were excluded. Preoperative renal function was estimated using the chronic kidney disease (CKD) staging system. Postoperative AKI was defined by the RIFLE criteria (Risk, Injury, Failure, Loss of function, End-stage renal disease). CRD was defined as progression in CKD stage or estimated glomerular filtration rate (eGFR) decline of >20%.Results
Among 451 elective OS, 111 underwent repair for P/JRAA. Three patients were excluded because of preoperative hemodialysis. Consequently, 108 patients were enrolled. Preoperatively, 41 patients (38.0%) had CKD stage 3 (eGFR < 60 mL/min/1.73 m2). Eight patients (7.2%) were in stage 4 (eGFR < 30 mL/min/1.73 m2). Proximal clamping was supraceliac (6 patients), suprarenal (34 patients), and inter-renal (68 patients). The median renal ischemic time was 33 minutes. The left renal vein was divided in 24 patients. Fourteen renal arteries in 14 patients were revascularized. Cold renal perfusion was applied in 11 patients. One in-hospital death was excluded from these analyses. AKI was observed in 20 patients (18.7%). One patient required temporary hemodialysis. During a median renal function follow-up for 24.5 months (interquartile range, 3.34-48.4), 17 patients (15.9%) had CRD. One patient required hemodialysis 5 years after surgery. In univariate analysis, CKD stages 3 and 4 were significant predictors for CRD (P = .014 and P < .001, respectively). Cold renal perfusion was associated with a higher risk of CRD (P = .047). On multivariate analysis, preoperative CKD stage 3 (hazard ratio, 4.22; 95% confidence interval, 1.10-16.3; P = .036) and stage 4 (hazard ratio, 59.72; 95% confidence interval, 10.13-352.0; P < .001) were identified as risk factors. In patients with CKD stage ≤2, the estimated freedom from CRD at 5 years was 96.6 ± 3.4%.Conclusions
CKD stage ≥3 was a significant risk for CRD after OS for P/JRAA. Renal artery clamping seemed innocuous for patients with a preoperative eGFR of ≥60 mL/min/1.73 m2 in terms of CRD. No significant impact of left renal vein division on CRD was confirmed. 相似文献5.
Farrukh M. Koraishy Denise Hooks-Anderson Joanne Salas Michael Rauchman Jeffrey F. Scherrer 《International urology and nephrology》2018,50(3):501-508
Background
Fast glomerular filtration rate (GFR) decline is associated with adverse outcomes, but the associated risk factors among patients without chronic kidney disease (CKD) are not well defined.Methods
From a primary care registry of 37,796, we identified 2219 (6%) adults with at least three estimated (e)GFR values and a baseline eGFR between 60 and 119 ml/min/1.73 m2 during an observation period of 8 years. We defined fast GFR decline as > 5 ml/min/1.73 m2 per year. The outcome measure was incident CKD (eGFR < 60 ml/min/1.73 m2). Clinical and demographic characteristics were compared using Chi-square and independent-samples t tests.Results
Older age, African-American race, unmarried status, hypertension and type 2 diabetes were more common in both fast decliners and those who developed incident CKD (p < 0.0001 to < 0.05). Lower neighborhood socioeconomic status, current smoking and baseline eGFR 90–119 ml/min/1.73 m2 were associated with fast decline (p < 0.01), while baseline eGFR 60–74 ml/min/1.73 m2 with incident CKD (p < 0.05). In multivariate regression models, among fast decliners with mildly reduced baseline eGFR (60–89 ml/min/1.73 m2), older age was significantly associated with incident CKD [odds ratio (OR) 1.04; 95% CI 1.01–1.08], and among those with normal baseline eGFR (≥ 90–119 ml/min/1.73 m2), type 2 diabetes was significantly associated with incident CKD (OR 3.83; 95% CI 1.35–10.89).Conclusions
Among primary care patients without CKD, GFR is checked infrequently. We have identified patients at high risk of progressive CKD, in whom we suggest a closer monitoring of renal function.6.
J.C. Na J.S. Park M.-G. Yoon H.H. Lee Y.E. Yoon K.H. Huh Y.S. Kim W.K. Han 《Transplantation proceedings》2018,50(4):1018-1021
Background
Although renal function recovery of living kidney donors has been reported in a number of studies, many patients show poor recovery, and the long-term prognosis of these patients has not been well studied. In this investigation we explored the long-term prognosis of renal function in patients with chronic kidney disease (CKD) at 1 year after nephrectomy.Methods
Patients who underwent donor nephrectomy during the period from March 2006 to April 2014, with a follow-up creatinine study at 1 year postoperatively and more than 3 years of follow-up, were included in the study. Creatinine and estimated glomerular filtration rate (eGFR, using the Modification of Diet in Renal Disease formula) before and after surgery were studied. Age, sex, history of hypertension or diabetes, body mass index, blood pressure, complete blood count, preoperative routine serum chemistry, and urine study results were reviewed.Results
Among 841 patients who had donor nephrectomy, 362 were included in the study. There were 111 patients (30.6%) with eGFR <60 mL/min/1.73 m2 at 1 year postsurgery, and the median follow-up period was 62.8 months (interquartile range [IQR] 42.0–86.3 months). The maximum eGFR after 3-year follow-up was studied, and 48 patients (43.2%) never recovered eGFR to >60 mL/min/1.73 m2. Age, history of hypertension, preoperative eGFR, and eGFR at 1 year were predictive factors at univariate analysis. Multivariate analysis of these factors was studied, and age (52.5 [IQR 47–55.7] vs 47 [IQR 7–53] years, odds ratio [OR] 1.1, 95% confidence interval [CI] 1.02–1.15, P = .007), history of hypertension (16.7% vs 1.6%, OR 10.0, 95% CI 1.09–92.49, P = .042), and eGFR at 1 year (53.9 [IQR 50.3–56.0] vs 57.0 [IQR 54.2–58.4] mL/min/1.73 m2, OR 0.8, 95% CI 0.72–0.92, P = .002) remained as significant risk factors.Conclusion
Of all living donors, 15.7% had CKD after >3 years of follow-up. Close observation is warranted when donors have CKD after 1 year follow-up, as 43.2% fail to recover renal function. Patients who are older, have a history of hypertension, and have low eGFR at 1-year follow-up are especially at risk. 相似文献7.
J.C. Na J.S. Park M.-G. Yoon H.H. Lee Y.E. Yoon K.H. Huh Y.S. Kim W.K. Han 《Transplantation proceedings》2018,50(4):1022-1024
Background
Many living kidney donors are still at risk of chronic kidney disease (CKD) 1 year after nephrectomy. Although some donors still experience poor renal function, many exhibit delayed recovery of renal function afterwards. We studied the factors related to delayed recovery of renal function in patients with CKD at 1 year after nephrectomy.Methods
Patients who underwent donor nephrectomy from March 2006 to April 2014 with a follow-up creatinine study at 1 month, 6 months, 1 year, and after 3 years of follow-up were included in the study. Age, sex, history of hypertension or diabetes, body mass index, blood pressure, complete blood cell count, preoperative routine serum chemistry, and urine study results were reviewed.Results
Among 275 donors, 83 (30.2%) who had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 at 1 year of follow-up were included in the study, and the eGFR was observed during a median follow-up of 62.0 months (interquartile range [IQR], 48.9–83.1 months). Those who had improvements in eGFR of >5 mL/min/1.73 m2 were included in the recovery group (n = 48 [57.8%]), and those who did not were included in the nonrecovery group (n = 35 [42.2%]). The preoperative and 1-year follow-up eGFR did not differ significantly between the 2 groups, and the maximum eGFR after 3 years was higher in the recovery group (68.68 mL/min/1.73 m2 [IQR, 61.81–75.64 mL/min/1.73 m2] vs 55.63 mL/min/1.73 m2 [IQR, 51.73–58.29 mL/min/1.73 m2]; P < .001). The recovery group was more likely to have a history of hypertension (4.2% vs 20%; P = .032), a lower body mass index (24.11 kg/m2 [IQR, 22.04–25.20 kg/m2] vs 25.25 kg/m2 [IQR, 23.23–26.44 kg/m2]; P = .01), and a lower preoperative uric acid level (4.7 mg/dL [IQR, 3.8–5.4 mg/dL] vs 5.3 mg/dL [IQR, 4.4–6.2 mg/dL]; P = .031). After multivariate logistic regression analysis, history of hypertension (odds ratio, 0.131; P = .022) and uric acid level (odds ratio, 0.641; P = .036,) remained as significant factors.Conclusions
Although 30.2% of donors had CKD at 1 year after nephrectomy, 57.8% reported improved renal function. Those with a history of hypertension and high preoperative uric acid levels were less likely to have improvements in renal function and required close follow-up. 相似文献8.
Y.-C. Huang Y.-S. Chang C.-C. Chen S.-F. Tsai T.-M. Yu M.-J. Wu C.-H. Chen 《Transplantation proceedings》2018,50(4):1083-1086
Background
Liver type fatty acid binding protein (L-FABP) is abundant not only in the liver but also in the kidney and is excreted in urine. Its primary function is to facilitate intracellular long chain fatty acid transport and it might also act as an endogenous antioxidant molecular. The purpose of this study was to investigate whether plasma or urinary L-FABP levels were associated with graft function in renal transplant recipients.Patients and methods
Sixty-seven renal transplant recipients with a mean age of 48.8 years were recruited. The mean duration of renal transplantation was 4131 days. Recipients were divided into 2 groups based on their estimated glomerular filtration rate (eGFR) values: moderate graft function (eGFR ≥60 mL/min/1.73 m2) and low graft function (eGFR <60 mL/min/1.73 m2). Fasting plasma and urinary L-FABP levels were measured.Results
There was no significant difference in plasma L-FABP level between the 2 groups, although recipients in the low graft function group had significantly lower urinary L-FABP level when compared with recipients in the moderate graft function group. Plasma and urinary L-FABP levels were not associated with eGFR in the 67 recipients; however, urinary L-FABP level (β = ?1.24, P = .037) and level adjusted by urinary creatinine (β = ?0.75, P = .046) were significantly negatively associated with eGFR in recipients with low graft function after adjusting for potential confounders.Conclusion
Increased urinary L-FABP level seems to be a significant indicator of decreased graft function in renal transplant recipients with loss of graft function. 相似文献9.
H.H. Lee W.K. Han S.K. Kang K.H. Huh M.S. Kim S.I. Kim Y.S. Kim Y.E. Yoon 《Transplantation proceedings》2017,49(5):1023-1026
Background
Diethylenetriamine pentaacetic acid (DTPA) and multi-detector computed tomography (MDCT) can predict postoperative estimated glomerular filtration rate (eGFR) in a live kidney donor. Accordingly, we compared predicted eGFR measured by use of DTPA and MDCT.Methods
From January 2013 to May 2015, 264 live kidney donors were enrolled. All donors underwent preoperative DTPA and MDCT, and bilateral renal cortex volume was measured by use of MDCT. We estimated DTPA-eGFR [remaining split renal function (%) × preoperative eGFR] and Vol-eGFR [remaining renal volume/total renal volume (%) × preoperative eGFR] and analyzed DTPA-eGFR, Vol-eGFR, and Modification of Diet in Renal Disease (MDRD)-eGFR during week 1 and in months 1, 3, and 6. Additionally, we compared DTPA-eGFR and Vol-eGFR by use of the formula ΔeGFR (maximum eGFR minus minimum eGFR during 6 months).Results
The mean DTPA-eGFR and Vol-eGFR values (mL/min/1.73 m2) were 52.97 ± 10.32 and 51.26 ± 10.26, respectively. Predictions of the dominant side did not agree in 113 of 303 (37.3%) cases. Postoperative MDRD-eGFR exhibited a statistically significant correlation with total renal volume, DTPA-eGFR, and Vol-eGFR (P < .0001). A significant correlation was found between ΔeGFR and total renal volume, DTPA-eGFR, and Vol-eGFR (P < .0001). Receiver operating characteristic curves were generated to predict the possibility of eGFR <60 mL/min/1.73 m2 at 6 months, using DTPA-eGFR and Vol-eGFR, which indicated that DTPA-eGFR (area under the curve = 0.858; P < .0001) and Vol-eGFR (area under the curve = 0.878; P < .0001) could predict chronic kidney disease class III at 6 months.Conclusions
MDRD-eGFR, Vol-eGFR, and DTPA-eGFR were significantly correlated. Moreover, Vol-eGFR and DTPA-eGFR exhibited high predictive value for chronic kidney disease class III at 6 months, whereas Vol-eGFR was a good predictor of renal function recovery. 相似文献10.
Background
To retard progression of chronic kidney disease (CKD) and reduce end-stage kidney disease, it is important to detect acute kidney function worsening on CKD (AW-CKD) immediately and bring back their kidney functions to baselines by appropriate treatment. However, in general outpatient practice, it is difficult to detect the change in the slope of estimated glomerular filtration rate (eGFR).Methods
We made automatic calculation system for the rate of eGFR decline (ΔeGFR), and retrospectively observed the situation of AW-CKD among outpatients, who had visited all clinical departments of Steel Memorial Hirohata Hospital between May and August 2016, using the system. The patients with ΔeGFR over 20 mL/min/1.73 m2/year were classified into “Detected cases”, who were immediately detected AW-CKD by the attending physicians, and “Not detected cases”. For each stratum of ΔeGFR, subsequent eGFR recovery rates between two groups were compared.Results
Among 6719 outpatients, 865 had CKD stages G3–5 and of which 196 had ΔeGFR over 20 mL/min/1.73 m2/year. We revealed that, in cases of ΔeGFR over 30 mL/min/1.73 m2/year, eGFR recovery rates in “Detected cases” were significantly higher than those in “Not detected cases” (103.2 vs 43.9%, p?<?0.001). There were no differences in the clinical backgrounds except kidney function between two groups.Conclusion
In general outpatient practice, a substantial number of AW-CKD was latent. It is expected to improve kidney prognoses of outpatients having CKD through immediately detecting the patients, whose ΔeGFR over 30 mL/min/1.73 m2/year using the system and alerting the attending physicians on the electronic medical record.11.
Pyry P. Jämsä Niku K.J. Oksala Antti P. Eskelinen Esa R. Jämsen 《The Journal of arthroplasty》2018,33(1):230-234.e1
Background
In arthroplasty clinics, we tend to evaluate patient's kidney function looking at serum creatinine (SCr), while estimated glomerular filtration rate (eGFR) is recommended. We reported the prevalence of chronic kidney disease (CKD; eGFR <60 mL/min/1.73 m2) in different patient groups and investigated whether CKD is missed by evaluation based on SCr.Methods
Preoperative SCr values were used to calculate eGFR in 20,575 consecutive hip or knee arthroplasties.Results
Prevalence of CKD was 9%-12%. It was higher among older women, knee arthroplasty patients, and patients with hypertension, diabetes, or coronary disease. Using SCr instead of eGFR leads to missing CKD in up to 7% of the cases. In older women and older patients with body mass index <25 kg/m2, half of CKD cases were missed.Conclusion
Use of eGFR instead of SCr to detect CKD more accurately is recommended. 相似文献12.
Background
Chronic allograft dysfunction (CAD) is a main cause of graft failure in kidney transplantation.Methods
We retrospectively analyzed 279 kidney transplant recipients who survived with a functioning graft for at least 2 years. CAD was defined as chronic graft deterioration, excluding other specific causes. We defined the pattern of decline in estimated glomerular filtration rate (eGFR), as follows: (1) “plateau” was defined as decline in eGFR ≤2 mL/min/1.73 m2/year; “long plateaus” were those lasting more than 5 years; (2) “rapid decline” was a decrease in eGFR ≥20 mL/min/1.73 m2/year. Patients diagnosed with CAD were categorized according to the occurrence of rapid decline and/or long plateau as follows: group 1, neither rapid decline nor long plateau; group 2, rapid decline only; group 3, long plateau only; and group 4, both rapid decline and long plateau.Results
From a total of 81 graft losses, 51 (63%) failed because of CAD, with a median of 9.4 years. Sixteen patients belonged to group 1, 14 to group 2, 12 to group 3, and nine to group 4. Mean graft survival times in the four groups were 7.7 ± 1.1, 6.1 ± 3.1, 16.2 ± 2.5, and 10.8 ± 3.6 years, respectively (P < .001). There were significant differences among groups in donor age, year of transplantation, mean eGFR at baseline, and acute rejection rate after transplantation.Conclusions
The results indicate that this cohort of kidney transplant recipients who had CAD comprised subgroups with different clinical courses. 相似文献13.
Akihiro Kuma Bungo Uchino Yoko Ochiai Masatoshi Kawashima Kazuhiko Enta Masahito Tamura Yutaka Otsuji Akihiko Kato 《Clinical and experimental nephrology》2018,22(1):15-27
Background
It remains to be fully clarified whether there is a relationship between uncontrolled dyslipidemia and decline in estimated glomerular filtration rate (eGFR) in the general population. Therefore, this study’s aim was to test the association of dyslipidemia with changes in eGFR in apparently healthy working men.Methods
We retrospectively examined the annual medical check-up list of 14,510 male workers aged 20–60 years with eGFR?≥?60 mL/min/1.73 m2 at baseline, and then evaluated the association of the changes in the check-up parameters with a decline in eGFR during the 5-year observation period.Results
Mean age and eGFR were 38.5 years and 82.3 mL/min/1.73 m2 at baseline, respectively. Evaluated low-density lipoprotein cholesterol (LDL-C) (≥140 mg/dL) was a strong indicator of CKD development in participants (basal eGFR 60–90 mL/min/1.73 m2) without hypertension [odds ratio (95% confidence interval): 1.46 (1.12–1.90)] or diabetes mellitus (DM) [1.49 (1.23–1.82)]. When LDL-C normalized under 140 mg/dL during follow-up, the decline in eGFR was smaller in non-hypertensive participants [?5.9 (?14.4 to ?0.9) vs ?13.4 (?18.4 to ?4.5) mL/min/1.73 m2, p?<?0.05]. There was an inverse correlation between change of LDL-C and decline in eGFR (p for trend <0.001).Conclusion
Increased LDL-C levels are associated with the development of incident CKD and eGFR decline in young to middle-aged working men without hypertension and/or DM.14.
H.J. Kwon D.H. Kim H.R. Jang S.-H. Jung D.H. Han H.H. Sung J.B. Park J.E. Lee W. Huh S.J. Kim Y.-G. Kim D.J. Kim H.Y. Oh 《Transplantation proceedings》2017,49(9):1999-2006
Background
Despite compensatory hyperfiltration in remaining nephrons following donor nephrectomy, some donors show impaired renal adaptation and low estimated glomerular filtration rate (eGFR). We investigated the factors predicting early renal adaptation after nephrectomy and identified kidney donors at risk of inadequate renal adaptation.Methods
A total of 265 living kidney donors from 2010 to 2013 were retrospectively analyzed. Renal function was serially followed for 6 months after the operation. Regression analyses were performed to identify the independent predictors of low eGFR (eGFR <60 mL/min/1.73 m2) and impaired renal adaptation (%Modification of Diet in Renal Disease [MDRD] <66% of baseline eGFR).Results
A total of 148 donors belonged to the low eGFR group, and changes in eGFR (ΔeGFR) at postoperative (PO) 1 day and 1 month were identified as independent predictors of low eGFR. Impaired renal adaptation was related to age, ΔeGFR PO 2–3 days, and ΔeGFR PO 1 month. Early renal adaptation was associated with age, male gender, and residual kidney computerized tomography angiography (CTA) volume. The best sensitivity and specificity were obtained with a cutoff value of ΔeGFR 31 at PO 1 day and 1 month for predicting low eGFR and with a value of ΔeGFR 27 at PO 2–3 days and 1 month for predicting impaired renal adaptation.Conclusions
Our study showed that the degree of early renal adaptation determines subsequent renal function in kidney donors. Closer monitoring and management may be required in old or male donors with small residual CTA kidney volume as well as donors with persistent ΔeGFR >27 within 1 month of nephrectomy. 相似文献15.
Soichiro Kon Tsuneo Konta Kazunobu Ichikawa Koichi Asahi Kunihiro Yamagata Shouichi Fujimoto Kazuhiko Tsuruya Ichiei Narita Masato Kasahara Yugo Shibagaki Kunitoshi Iseki Toshiki Moriyama Masahide Kondo Tsuyoshi Watanabe 《Clinical and experimental nephrology》2018,22(2):346-352
Background
Chronic kidney disease is a significant risk factor for end-stage kidney disease, cardiovascular events, and premature death. However, the prognostic value of low estimated glomerular filtration rate (eGFR) in the elderly is debatable.Methods
We determined eGFR using the Japanese equation in 132,160 elderly subjects (65–75 years) who attended the special health checkup (Tokutei-Kenshin) in 2008 and investigated the association between baseline eGFR and 5-year all-cause and cardiovascular mortality.Results
The median (SD) eGFR was 70.5 ± 15.3 mL/min/1.73 m2. During follow-up, we noted 2045 all-cause deaths including 408 from cardiovascular events. A J-shaped curve was obtained when all-cause and cardiovascular mortality rates were compared with decreases in eGFR, with the highest mortality observed for eGFR <45 mL/min/1.73 m2. These trends were statistically significant in the Kaplan–Meier analysis (P < 0.001). In the Cox proportional hazard analysis, after adjusting for possible confounders, those with eGFR <45 mL/min/1.73 m2, but not eGFR 45–59 mL/min/1.73 m2 showed a higher all-cause and cardiovascular mortality than those with eGFR >90 mL/min/1.73 m2 [hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.06–1.91 for all-cause mortality, HR 2.28, 95% CI 1.28–4.03 for cardiovascular mortality]. Sex-based subgroup analyses showed similar results for both men and women.Conclusions
We conclude that eGFR <45 mL/min/1.73 m2 is an independent risk factor for all-cause and cardiovascular mortality in the elderly population.16.
M. Dürr N. Lachmann B. Zukunft D. Schmidt K. Budde S. Brakemeier 《Transplantation proceedings》2017,49(8):1747-1756.e1
Background
Conversion to belatacept at a later point after kidney transplantation (KT) as a rescue therapy has been shown to be beneficiary in an increasing number of patients, but prognostic factors for a favorable outcome have never been investigated.Methods
The present study analyzed all KT patients after late conversion to belatacept in a single center regarding graft survival and changes in estimated glomerular filtration rate (eGFR), proteinuria, and mean fluorescence intensity (MFI) of donor-specific antibodies (DSA).Results
A total of 69 KT patients were converted to belatacept. eGFR increased from 28.9 ± 18.2 mL/min/1.73 m2 at time of conversion to 34.8 ± 20.1 mL/min/1.73 m2 after 18 months (P = .025). After conversion, 26/69 patients (37.7%) showed a sustained increase in eGFR of >5 mL/min/1.73 m2 after 12 months and were defined as responders. All other patients (43/69, 62.3%) were defined as nonresponders. In multivariate analysis, nonresponders presented with significantly higher proteinuria (552 ± 690 vs 165 ± 158 mg/L; P = .004) at the time of conversion. Changes of eGFR from before conversion and the time of conversion were similar in both subgroups (?5.7 ± 9.2 and 29.2 ± 17.3 mL/min/1.73 m2 in responders and ?4.6 ± 10.7 and 28.7 ± 19.0 mL/min/1.73 m2 in nonresponders). HLA antibody panel reactivity did not change after conversion. DSA-MFI was higher in nonresponders (7,155 ± 6,785) than in responders (2,336 ± 2,173; P = .001). One patient (1/69, 1.4%) developed de novo DSA after conversion, and no antibody-mediated rejection was diagnosed within 1,540 treatment months.Conclusions
Late conversion to belatacept is beneficiary for a subgroup of patients, with lower proteinuria at the time of conversion being an indicator for a favorable outcome. 相似文献17.
Aixia Ma Fuqiang Liu Chuan Wang Kai Liang Fei Yan Xinguo Hou Jinbo Liu Li Chen 《International urology and nephrology》2018,50(12):2239-2244
Background
Metabolic syndrome (MetS) has been found to be associated with an increased risk for chronic kidney disease (CKD). However, the relationship between insulin resistance (IR), which is believed to play a central role in the pathogenesis of MetS, and CKD is still unclear in Chinese adults and needs further investigation.Methods
This 3-year follow-up study included 3237 middle-aged and elderly Chinese without CKD at baseline. Estimated glomerular filtration rate (eGFR) 60–90 mL/min/1.73 m2 was defined as the mildly reduced eGFR; CKD was defined as eGFR?<?60 mL/min/1.73 m2. MetS was defined based on the China guideline for type 2 diabetes. IR was measured by the homeostatic model assessment of IR (HOMA-IR). Incidences of mildly reduced eGFR and CKD from normal eGFR were calculated. The roles of MetS and IR in predicting the progression of CKD were estimated using multiple logistic regression models.Results
The incidences of CKD and mildly reduced eGFR for the entire cohort were 20.08 and 33.28 per 1000 person-years, respectively. A large proportion [13.1% (182/1394)] of patients with mildly reduced eGFR progressed to CKD in 3 years. After accounting for age, gender, five components of MetS and HOMA-IR in multiple logistic regression model, only IR presented increased OR (1.119, 95% CI 1.052–1.189, p?<?0.001) for CKD. When we included MetS instead of its five components in model, both MetS (OR 1.420, 95% CI 1.020–1.977, p?=?0.038) and HOMA-IR (OR 1.118, 95% CI 1.055–1.186, p?<?0.001) showed increased risk for CKD progression.Conclusions
Both IR and MetS accelerate the progression of CKD among Chinese adults. Single metabolic abnormality did not have enough potency to induce the occurrence of CKD in 3 years.18.
H.H. Lee S.K. Kang Y.E. Yoon K.H. Huh M.S. Kim S.I. Kim Y.S. Kim W.K. Han 《Transplantation proceedings》2017,49(5):940-943
Objective
It was reported that a metabolic syndrome affected the remaining renal function after living donor nephrectomy. However, the measurement of waist circumference is unclear because it cannot distinguish between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). We investigate the clinical correlation between body adipose tissue and renal function recovery after living donor nephrectomy.Methods
From July 2013 to February 2015, 75 living kidney donors were enrolled. The VAT and SAT were measured by preoperative computed tomography (CT) scan. Body mass index (BMI), VAT, SAT, and VAT-to-SAT ratio were analyzed according to a postoperative renal function recovery. Receiver operating characteristic (ROC) was performed to predict estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 at postoperative 6 months for BMI, VAT, SAT, and VAT-to-SAT ratio.Results
The lowest value of eGFR (57.52 ± 11.20 mL/min/1.73 m2) was measured at postoperative day 7. There was no statistically significant difference in eGFR between 1 month and 3 months. BMI, VAT, SAT, and VAT-to-SAT ratio showed a statistically significant correlation with each other (Pearson correlation, P < .05). Also, the recovery time of eGFR was correlated with VAT-to-SAT ratio; it was significant at postoperative 1, 3, and 6 months. VAT-to-SAT ratio (0.654, 95% confidence interval 0.525–0.783, P = .024) had higher predictive value in ROC.Conclusion
We developed a new variable to predict the value of lower eGFR (less than 60 mL/min/1.73 m2) at a postoperative 6 months in living kidney donor. According to a CT scan, VAT-to-SAT ratio can predict renal function recovery. 相似文献19.
Shang-Feng Tsai Kuo-Hsiung Shu Ming-Ju Wu Hao-Chung Ho Mei-Chin Wen Chung-Kwang Su Jong-Da Lian Cheng-Hsu Chen 《World journal of surgery》2013,37(4):923-929
Background
The risk of developing chronic kidney disease (CKD) among living kidney donors (LKDs) is seldom included in evaluations of patients’ outcomes. Potential risk factors and new criteria for estimating the glomerular filtration rate (eGFR) indexed for body surface area (BSA) were investigated with a view to prevent the development of CKD in LKDs.Methods
We conducted a retrospective study of LKDs from May 1983 to March 2011. The Mann–Whitney U test and χ2 test were used to analyze the male versus female groups. Survival analysis was plotted as CKD-free survival and analyzed separately by different eGFR index classifications. The Cox regression model was used to identify potential risk factors for development of CKD.Results
A total of 105 LKDs with a mean age of 46.3 ± 12.5 years had a mean eGFR indexed for BSA of 88.9 ± 21.5 ml/min per 1.73 m2. After a mean duration of 5.4 ± 4.9 years’ follow-up, eGFR dropped to 61.4 ± 16.4 ml/min per 1.73 m2 (p = 0.002). Median CKD-free survival was only 5.7 years. The difference between eGFR ≥ 80 ml/min per 1.73 m2 and <80 ml/min per 1.73 m2 was not statistically significant (p = 0.980). Multivariate Cox regression analysis showed that higher eGFR at donation (HR = 0.952, p = 0.0199) could be a protective factor. The receiver operating characteristic (ROC) curve for initial eGFR with best sensitivity of 52.78 % and specificity of 81.40 % was obtained with a cutoff value of 90.2 ml/min per 1.73 m2 for preoperative eGFR. An eGFR of 90 ml/min per 1.73 m2 yielded a significant survival curve (p = 0.0199) after 21 years of follow-up. Further classifications of eGFR >90 ml/min per 1.73 m2 into 90–99 ml/min per 1.73 m2, 100–109 ml/min per 1.73 m2, and ≥110 ml/min per 1.73 m2 were examined, but this survival curve was not statistically significant (p = 0.1247).Conclusions
Living kidney donors will develop CKD after a long duration of follow-up if there is insufficiently high eGFR at donation. An eGFR above 90 ml/min per 1.73 m2 before donation is the only factor that predicts prevention of CKD. Larger studies with longer duration of follow-up are necessary to clarify the clinical outcome of this postoperative CKD group, especially for patients with eGFR between 80 and 90 ml/min per 1.73 m2. 相似文献20.
Y. Nakagawa M. Ikeda T. Ando M. Tasaki K. Saito K. Takahashi A. Aikawa M. Kikuchi K. Akazawa Y. Tomita 《Transplantation proceedings》2017,49(1):10-15
