Non-Indexed vs. Body Surface Area Indexed Measured Glomerular Filtration Rate Determinations as a Criterion of Living Donor Acceptance.

IF 8.5 1区 医学 Q1 UROLOGY & NEPHROLOGY
Abraham J Matar,Erika S Helgeson,Jesse C Seegmiller,Karthik Ramanathan,Erik B Finger,Raja Kandaswamy,Timothy L Pruett,Matthew Wright,Jessica Fisher,Rasha El-Rifai,Richard Spong,Arthur J Matas,Vanessa Humphreville
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引用次数: 0

Abstract

INTRODUCTION When GFR is measured (mGFR) using iohexol plasma clearance, results are reported both as a "non-indexed" (mL/min) and "body-surface area (BSA) indexed" to 1.73 m2. When these two values differ, there is no consensus as to which is preferable to use to determine suitability for living kidney donation (LKD). We sought to compare the difference between non-indexed and BSA indexed mGFR in LKDs and the association with postdonation estimated GFR (eGFR). METHODS Between 1/1/2007-1/1/2023, 627 adult LKDs at the University of Minnesota had predonation mGFR by iohexol plasma clearance and a minimum six-month follow-up. LKD acceptance was based on a non-indexed mGFR ≥80 ml/min (age <60) or ≥75 ml/min (age ≥60). Primary outcomes included eGFR at one-year postdonation and sustained eGFR <45 mL/min/1.73m2. RESULTS Among 627 LKDs, 561 (90%) had both a non-indexed and BSA indexed mGFR above the age-based threshold (concordant), while 66 (11%) had non-indexed measurements above and BSA indexed below (discordant). Compared to concordant LKDs, discordant LKDs were older (median: 54.1 years vs. 42.8 years, p <0.001) and had higher body mass indices (28.0 vs. 26.1, p <0.001). At one-year postdonation, mean eGFR was higher among concordant LKDs, although the difference in relative change from pre-donation eGFR measurements was similar. During a median follow up of 2.3 years, six out of 66 (9%) discordant LKDs experienced sustained eGFR <45 mL/min/1.73m2 compared to five out of 561 (0.9%) concordant LKDs (hazard ratio: 10.7, 95% confidence intervals: 3.21 to 35.6). CONCLUSION Discordant LKDs had lower eGFR measurements postdonation and experienced a higher risk for eGFR <45 mL/min/1.73m2.
非指数化vs体表面积指数化测量肾小球滤过率作为活体供体接受的标准。
导言当使用碘海醇血浆清除率测量 GFR(mGFR)时,结果会以 "非指数"(毫升/分钟)和 "体表面积(BSA)指数"(1.73 平方米)两种形式报告。当这两个值不同时,在确定是否适合活体肾脏捐献(LKD)时,哪一个更可取还没有达成共识。我们试图比较 LKD 非指数化和 BSA 指数化 mGFR 之间的差异以及与捐肾后估计 GFR (eGFR) 的关联。方法2007 年 1 月 1 日至 2023 年 1 月 1 日期间,明尼苏达大学的 627 名成年 LKD 通过碘己醇血浆清除率测定了捐肾前的 mGFR,并进行了至少 6 个月的随访。接受 LKD 的标准是非指数 mGFR ≥80 毫升/分钟(年龄<60)或≥75 毫升/分钟(年龄≥60)。结果在 627 名 LKD 中,561 人(90%)的非指数化和 BSA 指数化 mGFR 均高于基于年龄的阈值(一致),而 66 人(11%)的非指数化测量值高于而 BSA 指数化测量值低于(不一致)。与一致的 LKD 相比,不一致的 LKD 年龄更大(中位数:54.1 岁对 42.8 岁,P <0.001),体重指数更高(28.0 对 26.1,P <0.001)。在捐献后一年,尽管与捐献前的 eGFR 测量值相比相对变化的差异相似,但 LKD 一致者的平均 eGFR 值更高。在中位 2.3 年的随访期间,66 例不一致的 LKD 中有 6 例(9%)eGFR 持续<45 mL/min/1.73m2,而 561 例一致的 LKD 中有 5 例(0.9%)(危险比:10.7,95% 置信区间:3.21 至 35.6)。
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来源期刊
CiteScore
12.20
自引率
3.10%
发文量
514
审稿时长
3-6 weeks
期刊介绍: The Clinical Journal of the American Society of Nephrology strives to establish itself as the foremost authority in communicating and influencing advances in clinical nephrology by (1) swiftly and effectively disseminating pivotal developments in clinical and translational research in nephrology, encompassing innovations in research methods and care delivery; (2) providing context for these advances in relation to future research directions and patient care; and (3) becoming a key voice on issues with potential implications for the clinical practice of nephrology, particularly within the United States. Original manuscript topics cover a range of areas, including Acid/Base and Electrolyte Disorders, Acute Kidney Injury and ICU Nephrology, Chronic Kidney Disease, Clinical Nephrology, Cystic Kidney Disease, Diabetes and the Kidney, Genetics, Geriatric and Palliative Nephrology, Glomerular and Tubulointerstitial Diseases, Hypertension, Maintenance Dialysis, Mineral Metabolism, Nephrolithiasis, and Transplantation.
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