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Konesans

Ekwasyon kolaborasyon epidemyoloji maladi ren kwonik modifye pou pousantaj filtraj glomerulè yo pi byen asosye ak komorbidite pase lòt ekwasyon nan donatè ren vivan yo nan Japon Ⅱ

Jan 30, 2024

Rezilta yo

Done debaz yo prezante nan Tablo 1. Nou konpare mwayen aneGFR for the three types of equations between the elderly (age >70 ane fin vye granmoun) ak gwoup ki pa granmoun aje ak ant gwoup komorbidite-pozitif ak komorbidite-negatif (Tablo 2) ak obsève diferans enpòtan ant gwoup yo granmoun aje ak ki pa granmoun aje pou tout twa eGFR yo. Lè w konpare eGFR/Jm-eGFR mwayèn,obezite, tansyon wo, epiCVD ekspozediferans enpòtan. Lè w konpare eGFR/Jm-MDRD an mwayèn, yo te detekte diferans enpòtan sèlman nan obezite. Lè w konpare eGFR/Jm-CKD-EPI an mwayèn,obezite, tansyon wo, dyabèt, ak CVD montre diferans enpòtan. Pa gen okenn diferans enpòtan nan eGFR mwayèn yo te obsève pou konjesyon serebral lè l sèvi avèk chak ekwasyon.

The positive rates of the 5 comorbidities in the elderly (age >70 ane fin vye granmoun) ak gwoup ki pa granmoun aje yo montre nan Fig. 2. Pousantaj yo pozitif poutansyon wo, diabetes, stroke, and CVD were two to three times higher in the elderly than in the non-elderly group. Chi-square tests for an older age (>70 ane) ak pousantaj komorbidite yo te montre diferans enpòtan (p<0.001).

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    Korelasyon ki genyen ant laj akeGFR kalkilelè l sèvi avèk 3 ekwasyon yo te enpòtan (p<0.001). The R2 of the eGFR/Jm-CKD-EPI (R2 =0.509) was larger than that of the eGFR/Jm-eGFR (R2 =0.150) and eGFR/Jm-MDRD (R2 = 0.083).

    Fig. 3a montre analiz ROC ant eGFR yo kalkile lè l sèvi avèk twa ekwasyon yo ak lasenk komorbidite nan obezite, tansyon wo, dyabèt, CVD, and stroke. The ROC curves of the eGFR/Jm-CKD-EPI exhibited a leftward shift compared with those of the eGFR/Jm-eGFR and eGFR/ Jm-MDRD about the comorbidities. In particular, regarding the relationship with older age (>70 years old), the area under the ROC curve (AUROC) for the eGFR/JmCKD-EPI was much larger, (0.859) than that for the eGFR/ Jm-eGFR (0.674) and eGFR/Jm-MDRD (0.636). Fig. 3b shows the results of the ROC analysis between the eGFR calculated using the 3 equations and the 5 comorbidities, excluding an older age (>70 ane), (n=798). Koub ROC nan eGFR/Jm-CKD-EPI te prezante yon chanjman nan goch konpare ak sa yo nan eGFR/Jm-eGFR ak eGFR/Jm MDRD sou komorbidite yo. Pousantaj komorbidite yo, sètadi<70 mL/min/1.73 m2, 70- 80 mL/min/1.73 m2, and  80 mL/min/1.73 m2, in the 3 eGFR groups are presented in Table 3. All five comorbidities showed significant differences only in the group with eGFR/Jm-CKD-EPI, and the comorbidity rates in the group with eGFR/Jm-CKD-EPI <70 mL/min/1.73 m2 were higher than those in the group with eGFR - 70 mL/min/1.73 m2.

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    Diskisyon

    Nan twa eGFR yo, eGFR/Jm-CKD-EPI te korelasyon pi sansib ak komorbidite yo. eGFR/Jm-CKD-EPI, eGFR/Jm-eGFR, ak eGFR/Jm-MDRD te detekte diferans enpòtan nan kat, twa, ak youn nan senk komorbidite yo, respektivman (Tablo 2). Nan analiz ROC yo (Fig. 3), eGFR/Jm-CKD-EPI a te siperyè an tèm de relasyon ki genyen ant komorbidite. Yon analiz tandans (Table 3) revele siperyorite eGFR/Jm-CKD-EPI nan n bès eGFR (Fig. 3).

    Pandan evalyasyon kandida donatè anvan transplantasyon, eGFR/CKD-EPI ka itilize pou premye evalyasyon an. Swen siplemantè ta dwe bay pasyan ki te resevwa don nan men donatè ki gen yon eGFR/CKD-EPI ki ba (<70 mL/min/1.73 m2 ), which is most strongly associated with the five comorbidities and an older age (Table 3). Compared to donations from healthy living donors, those from living donors with medical conditions (so-called expanded criteria donors) exhibited a high incidence of overall and death-censored graft loss according to multivariable Cox proportional hazards analyses (hazard ratios=2.16 and 3.25, p= 0.015 and 0.004, respectively) (7).

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    Figure 3. a: The AUROC using the ROC analysis for the relationship with comorbidities calculated by the eGFR using the three equations of Jm-eGFR, Jm-MDRD, and Jm-CKD-EPI. The AUROC is shown graphically for each ROC analysis between the eGFR and comorbidities. n=8,176. b: The AUROC using the ROC analysis for the relationship with comorbidities calculated by the eGFR using the three equations of Jm-eGFR, Jm-MDRD, and Jm-CKD-EPI, excluding the elderly (age >70 ane). n=7,378. AUROC: zòn anba koub karakteristik fonksyònman reseptè a, ROC: karakteristik fonksyònman reseptè a, AUC: zòn anba koub la, BMI: endèks mas kò, eGFR: pousantaj filtraj glomerulè estime, HT: tansyon wo, DM: dyabèt, CVD: maladi kadyovaskilè, Jm : Japonè modifye, MDRD: Modification of Diet in Renal Disease, CKD-EPI: Kolaborasyon epidemyoloji maladi ren kwonik. Liy wouj la se Jm-CKD-EPI, liy ble a se Jm-eGFR, ak liy vèt la se Jm-MDRD.

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    Nan etid kwa-seksyonèl, yon eGFR/CKD-EPI ki pi ba te montre yon pi bon asosyasyon ak prévalence de komorbidite pase eGFR/MDRD nan popilasyon Kokasyen ki rete nan kominote a. Tarantini et al. (4) rapòte ke nan pasyan ki gen CVD, prévalence de CVD te pi wo lè evalye eGFR/CKD-EPI pase lè evalye eGFR/MDRD nan gwoup eGFR ki ba. Juutilainen et al. (13) te evalye pousantaj komorbidite yo, sètadi tansyon wo, obezite, dyabèt, ak CVD, nan pasyan ki gen CKD ak obsève yon prévalence siyifikativman pi wo nan pasyan ki gen komorbidite lè yo te fè evalyasyon an lè l sèvi avèk eGFR/CKD-EPI pase lè li te fèt. lè l sèvi avèk eGFR/MDRD la.

    Nou konfime presizyon eGFR/Jm-CKD-EPI a nan literati a. Rule et al. (14) te rapòte ke ekwasyon CKD-EPI a te pi egzak pase MDRD nan popilasyon ki pa gen anpil risk, ki gen ladan donatè ren pre-don ak apre don. Murata et al. (15) rapòte ke eGFR / CKD-EPI ki baze sou kreyatinin te demontre mwens patipri pase eGFR / MDRD nan donatè potansyèl LKT (-8% vs -18%). Burballa et al. (16) ak Gaillard et al. (17) te konpare valè eGFR/CKD-EPI, eGFR/MDRD, ak mGFR ki baze sou kreyatinin ak izotòp nan donatè LKT preoperativ yo epi li te konkli ke eGFR/CKD-EPI te gen rapò pi byen ak mGFR pase eGFR/MDRD. Horio et al. (18) konpare presizyon eGFR/Jm-CKD-EPI ak eGFR/Jm-MDRD ak GFR inulin ki mezire nan yon popilasyon tchèkòp sante nan Japon. Nan raj la nan mezire inulin GFR 60 mL/min/1.73 m2, prejije yo (mGFR-eGFR) yo te 7.3±20.6 mL/min/1.73 m2 nan eGFR/Jm-CKD-EPI ak 7.8 ±22.2 mL/min/1.73. m2 nan eGFR/Jm-MDRD, respektivman (p<0.001). Horio et al. (19) evaluated the accuracy of the eGFR/Jm-eGFR in potential LKT donors in Japan who received the inulin clearance test and observed a bias (mGFReGFR) of 18.3±16.4 mL/min/1.73 m2. Thus, the eGFR/JmeGFR underestimated the true GFR of LKT donors. Based on the two studies of Horio et al. (18, 19), the eGFR/JmCKD-EPI appears accurate for comparing measured inulin GFR values.

    We explored why the eGFR/Jm-CKD-EPI was superior regarding its relationship with the five evaluated comorbidties, as the reasons have not been examined in-depth in previous reports. The comorbidity rates were 2 to 3 times higher in the elderly group (age >70 years old) than in the non-elderly group (age  70 years old) among the LKT donors (Fig. 3). An ROC analysis revealed that the eGFR/JmCKD-EPI was better associated with older age (>70 ane fin vye granmoun) konpare ak eGFR / Jm-eGFR ak eGFR / Jm MDRD (Fig. 3a). Se konsa, nou kwè ke karakteristik ekwasyon sansiblite laj la responsab siperyorite eGFR/Jm-CKD-EPI la.

    Ji et al. etidye relasyon ki genyen ant eGFR la ak domaj ògàn sib preklinik nan tansyon wo lè l sèvi avèk yon analiz ROC e li te rapòte ke eGFR / Chinwa CKD-EPI ekwasyon an te pi byen asosye ak konplikasyon ipèrtansif pase eGFR / Chinwa ak Azyatik modifye ekwasyon MDRD (20). eGFR/CKD-EPI te pi byen asosye pase eGFR/MDRD ak epesè intra-medya, endèks cheviy-brachial, endèks mas vantrikulè gòch, rapò albumin-a-kreatinin pipi, ak vitès onn batman aortik. Nan etid nou an, rabè ka granmoun aje yo, eGFR/CKD-EPI te pi byen asosye ak komorbidite nan donatè LKT pase eGFR/Jm-eGFR ak eGFR/Jm-MDRD (Fig. 3b). Kidonk, eGFR/CKD-EPI a ta ka sansib pou konplikasyon ipèrtansif oswa ateroskleroz, eksepte faktè laj ki pi gran. Yo rekòmande eGFR/Jm-CKD-EPI pou itilize nan evalyasyon risk, pa sèlman pou domaj ren, men tou domaj sistemik nan ògàn, ki reflete konplikasyon tansyon wo nan donatè LKT.

    Yo rapòte eGFR/CKD-EPI a pi wo pase eGFR/MDRD nan prediksyon evènman CVD oswa mòtalite nan patisipan Blakaz (1-3). Nan patisipan Chinwa yo, eGFR/CKD-EPI a te yon pi bon prediktè nan repetisyon konjesyon serebral ak lanmò pase eGFR/MDRD (21). Konsiste tant, Matsushita, et al. (22) rapòte ke eGFR/Jm CKD-EPI a se te yon pi bon prediksyon risk pou tout kòz ak mòtalite kadyovaskilè pase eGFR/Jm-MDRD nan seri eGFR 60 mL/min/1.73. m2 nan patisipan Japonè yo. Terawaki et al. (3) te itilize yon analiz ROC pou konpare valè prediksyon pou CVD ak konjesyon serebral ant eGFR/Jm-CKD-EPI ak eGFR/Jm-MDRD e li te rapòte ke AUROC yo pou evènman CVD nan eGFR/Jm-CKD-EPI ak eGFR. /Jm-eGFR te 0.596 ak 0.562, respektivman. eGFR/CKD-EPI te asosye pi byen ak ensidans CVD nan 241,159 patisipan Japonè yo (laj mwayèn, 64 ane) ki te sibi yon tchèkòp sante jeneral. Ohsawa et al. (23) rapòte yon pi bon prediksyon pou mòtalite tout kòz, enfaktis myokad, ak konjesyon serebral ak eGFR/Jm-CKD-EPI pase ak eGFR/Jm-MDRD nan yon kòwòt tchèkòp sante. Kidonk, eGFR/CKD-EPI siperyè pou predi evènman CVD ak mòtalite nan popilasyon ki abite nan kominote a. Nou ta dwe ak anpil atansyon swiv ak donatè ki gen yon eGFR/CKD-EPI ki ba apre transplantasyon.

    cistanche-kidney disease-4(52)

    Several limitations associated with the present study warrant mention. The registry data had no data on the measured GFR, so we could not directly compare the accuracy of the three eGFR equations. We unfortunately had to exclude many cases with missing data from the analysis. These limitations might have resulted in the data being misclassified; however, our study has some important insights derived from its involvement of a large cohort of LKT donors (>8,000 ka).


    Konklizyon

    eGFR/Jm-CKD-EPI te pi byen asosye ak komorbidite, tankou obezite, tansyon wo, dyabèt, CVD, ak konjesyon serebral pase eGFR/Jm-eGFR ak eGFR/Jm MDRD nan popilasyon ki gen anpil risk, tankou donatè LKT Japonè yo. Pou evalyasyon inisyal fonksyon ren kandida donatè LKT yo, yo rekòmande eGFR/Jm-CKD-EPI, patikilyèman pou donatè kritè elaji ki gen komorbidite.


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