A Higher Glomerular Filtration Rate Predicts Low Risk of Developing Chronic Kidney Disease in Living Kidney Donors

作者：Tsai Shang Feng; Shu Kuo Hsiung; Wu Ming Ju; Ho Hao Chung; Wen Mei Chin; Su Chung Kwang; Lian Jong Da; Chen Cheng Hsu^*

来源：World Journal of Surgery, 2013, 37(4): 923-929.

DOI：10.1007/s00268-013-1906-z

Background The risk of developing chronic kidney disease (CKD) among living kidney donors (LKDs) is seldom included in evaluations of patients%26apos; 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. %26lt;br%26gt;Methods We conducted a retrospective study of LKDs from May 1983 to March 2011. The Mann-Whitney U test and chi(2) 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. %26lt;br%26gt;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 m(2). After a mean duration of 5.4 +/- 4.9 years%26apos; follow-up, eGFR dropped to 61.4 +/- 16.4 ml/min per 1.73 m(2) (p = 0.002). Median CKD-free survival was only 5.7 years. The difference between eGFR %26gt;= 80 ml/min per 1.73 m(2) and %26lt;80 ml/min per 1.73 m(2) 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 m(2) for preoperative eGFR. An eGFR of 90 ml/min per 1.73 m(2) yielded a significant survival curve (p = 0.0199) after 21 years of follow-up. Further classifications of eGFR %26gt;90 ml/min per 1.73 m(2) into 90-99 ml/min per 1.73 m(2), 100-109 ml/min per 1.73 m(2), and %26gt;= 110 ml/min per 1.73 m(2) were examined, but this survival curve was not statistically significant (p = 0.1247). %26lt;br%26gt;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 m(2) 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 m(2).

• 出版日期2013-4
• 单位中国医科大学