Cov kev hloov pauv hauv lub raum ua haujlwm ua raws li Kev Pab Cuam Tshuam Nyob Hauv Nephrectomy

Hu rau:joanna.jia@wecistanche.com/ WhatsApp: 008618081934791

Cistanche tuaj yeem pab rau lub raum ua haujlwm

Ngan N. Lam1,2, Anita Lloyd3, Krista L. Lentine4, Robert R. Quinn1,2, Pietro Ravani1,2, OPEN Brenda R. Hemmelgarn1,2, Scott Klarenbach3 thiab Amit X. Garg5,6,7

1 Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; 2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; 3 Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada; 4 Department of Medicine, Center for Abdominal Transplantation, Saint Louis University, St. Louis, Missouri, USA; 5 Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada; 6 Department of Epidemiology thiab Biostatistics, Western University, London, Ontario, Canada; thiab 7Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada

Kev nkag siab zoo dua ntawmlub raum ua haujlwmTom qab nyob tus neeg pub dawb nephrectomy thiab nws txawv li cas los ntawm tus cwj pwm pub dawb tuaj yeem qhia tus neeg mob xaiv, kev sab laj, thiab kev saib xyuas tom qab. Txhawm rau ntsuas qhov no, peb tau ua ib qho kev tshawb fawb txog kev ua neej nyobraumcov neeg pub dawb hauv Alberta, Canada nruab nrab ntawm {{0}}, siv cov chaw saib xyuas kev noj qab haus huv txuas nrog. Peb tau sib tw 604 tus neeg pub dawb rau 2,414 tus neeg noj qab haus huv uas tsis yog neeg pub dawb los ntawm cov pej xeem raws li hnub nyoog, poj niam txiv neej, xyoo ntawm kev nkag mus, kev nyob hauv nroog, thiab qhov kwv yees ntawm glomerular filtration rate (eGFR) ua ntej cohort nkag (nephrectomy hnub rau cov neeg pub dawb thiab randomly teem hnub rau cov tsis pub dawb). Cov txiaj ntsig tseem ceeb yog qhov hloov pauv ntawm eGFR lub sijhawm (qhov nruab nrab ntawm kev soj ntsuam xya xyoo; siab tshaj 15 xyoo). Lub hnub nyoog nruab nrab ntawm pawg pab pawg yog 43 xyoo, 64 feem pua ​​​​cov poj niam, thiab lub hauv paus (kev pub dawb ua ntej) eGFR yog 100 mL/min/1.73 m2. Zuag qhia tag nrho, txij li rau lub lis piam tom ntej, eGFR tau nce los ntawm D0.35 mL / min / 1.73 m2 hauv ib xyoos (95 feem pua ​​​​ntawm kev ntseeg siab D0.21 txog D0.48) hauv cov neeg pub dawb thiab txo qis los ntawm -0.85 mL/ min/1.73 m2 ib xyoos twg (-0.94 rau -0.75) nyob rau hauv kev sib raug zoo noj qab haus huv tsis pub dawb. Qhov hloov pauv hauv eGFR ntawm rau lub lis piam mus rau ob xyoos, ob mus rau tsib xyoos, thiab tshaj li tsib xyoos ntawm cov neeg pub dawb yog D1.06, D0.64, thiab -0.06 mL/min/1.73 m2 toj xyoo, raws li. Nyob rau hauv sib piv rau qhov tsis tu ncua muaj hnub nyoog txog kev poob rau hauvlub raum ua haujlwmhauv cov tsis pub dawb, tom qab pub dawblub raum ua haujlwmQhov nruab nrab pib nce los ntawm 1 mL / min / 1.73 m2 ib xyoos twg los ntawm glomerular hyperfiltration, uas tau pib toj siab los ntawm tsib xyoos tom qab pub dawb. Yog li, qhov kev hloov pauv nruab nrab hauv eGFR lub sijhawm dhau los yog qhov sib txawv ntawm cov neeg pub dawb thiab cov tsis pub dawb.

Tom qab pub dawb nephrectomy, muaj 25 feem pua ​​​​-40 feem pua ​​​​txo ntxov ntawm glomerular filtration rate (GFR), es tsis yog 50 feem pua ​​​​txo, vim qhov nyiaj them rov qab hyperfiltration ntawm qhov seem.raum.1–3 Kev tshuaj xyuas zoo ntawm 8 qhov kev tshawb fawb qhia tias 12 feem pua ​​​​ntawm cov neeg pub nyiaj tau tsim GFR ntawm 30 thiab 59 ml / min rau 1.73 m2, thiab 0.2 feem pua ​​​​tau muaj GFR<30 ml/min="" per="" 1.73="" m2="" over="" a="" mean="" follow-up="" that="" ranged="" between="" 3="" and="" 20="" years.1="" however,="" many="" studies="" that="" assessed="" post-donation="" renal="" function="" are="" limited="" by="" small="" sample="" sizes,="" lack="" of="" appropriate="" nondonor="" control="" groups,="" and="" significant="" loss="" to="" follow-up.1,4,5="" studies="" with="" more="" donors="" lost="" to="" follow-up="" demonstrate="" a="" larger="" decrement="" in="" gfr="" after="">

Kev tshawb nrhiav yav tom ntej nrog kev soj ntsuam zoo tshaj plaws tau tshaj tawm lub raum ua haujlwm ntawm 6 lub hlis, thiab 1, 2, thiab 3 xyoos tom qab pub dawb rau 182 nyob.raumCov neeg pub dawb thiab 173 qhov kev tswj tsis pub pub dawb.2 Thaum 3 xyoos ntawm kev soj ntsuam, qhov nruab nrab ntsuas GFR

los ntawm plasma iohexol tshem tawm rau cov neeg pub dawb yog 78 piv rau 104 ml / min rau kev tswj tsis pub pub dawb. Los ntawm lub hlis 6 mus rau 36, qhov ntsuas GFR rau txhua tus neeg pub dawb tau nce ntawm tus nqi txhua xyoo ntawm þ1.5 ml / min, thaum nws txo qis ntawm tus nqi txhua xyoo ntawm -0.4 ml / min rau kev tswj tsis pub pub dawb. Hauv txoj kev tshawb no, lub hnub nyoog tsis cuam tshuam qhov kev hloov pauv ntawm GFR ntsuas; Txawm li cas los xij, qhov kev tshawb fawb no tau txwv los ntawm lub sijhawm soj ntsuam luv luv.

Kev nkag siab zoo dua ntawm cov qauv hauv kev pub dawb tom qab GFR, thiab qhov no txawv ntawm tus neeg pub dawb li cas, tuaj yeem qhia txog kev ntsuam xyuas, kev xaiv, thiab kev sab laj txog kev ua neej nyob.raumcov neeg sib tw pub dawb. Kev paub txog cov kev pheej hmoo cuam tshuam nrog kev poob ntau dua ntawm kev pub dawb tom qab GFR kuj tseem tuaj yeem ua rau cov kws kho mob txheeb xyuas cov neeg pub dawb uas tuaj yeem tau txais txiaj ntsig los ntawm kev saib xyuas thiab saib xyuas. Peb tau ua qhov kev tshawb fawb rov qab los siv cov ntaub ntawv saib xyuas kev noj qab haus huv hauv Alberta, Canada los piav qhia txog cov xwm txheej tom qab pub dawb GFR hauv kev ua neej nyobraumpub dawb.

TSEEM CEEB

Cov yam ntxwv ntawm lub hauv paus

Peb sib phim 604 nyobraumpub rau 2414 noj qab haus huv tsis pub dawb los ntawm cov pej xeem. Cov yam ntxwv tseem ceeb rau pawg neeg sib tw tau nthuav tawm hauv Table 1. Cov hnub nyoog nruab nrab yog 43 xyoo (interquartile range [IQR], 33–51) thiab 64 feem pua

ACR. albumin-creatinine ratio: eGFR, kwv yees glomerular pom tus nqi: NA tsis muaj feem xyuam; PCR protein-creatinine piv.

Standardized difference provides a measure of the difference between groups divided by pooled SD. A value of >10 feem pua ​​​​yog txhais raws li qhov sib txawv ntawm cov pab pawg. Cov nyiaj tau los tau raug cais raws li qhov thib tsib ntawm cov nyiaj tau los hauv zej zog nruab nrab.

"Urban indicates a population >10,000 or a population >1000 with population density >400/km* ib. "Rau qhov kev ncua deb ntawm qhov chaw hloov pauv,> 500 km tau imputed li 500 km.

suav nrog txhua qhov kev mus ntsib / ntsuas, txawm tias ntau qhov kev mus ntsib / ntsuas tau tshwm sim nyob rau tib hnub.

Kev ntsuas qhov ntsuas tau raws li qhov ntsuas tsis ntev los no (tus neeg mob hauv tsev kho mob, tus neeg mob sab nraud, lossis chav kho mob xwm txheej ceev) hauv 1 xyoo ua ntej qhov ntsuas hnub ntsuas.eGFR tau suav nrog siv ChronicLub raumKab Mob-Kev Kab Mob Sib Kis Sib Koom Tes. Albuminuria tau txhais los ntawm ACR, PCR, lossis cov zis tso zis thiab categorized raws li Kab Mob Raum: Kev Txhim Kho Ntiaj Teb Cov Lus Txhais raws li tsis muaj / me (A1∶dipstick negative lossis kab, PCR<15 mg/mmol,="" or=""><30 mg/q）,="" moderate="" （a2∶="" dipstick="" 1十,="" pcr="" 15-50="" mg/mmol,="" or="" acr="" 30-300="" mg/g),="" and="" severe="" (a3:="" dipstick="" ≥2+,="" pcr="" ≥51="" mg/mmol,="" or="" acr="" ≥301="">

comorbid tej yam kev mob yog raws li algorithms ntawm kev kuaj mob los yog cov txheej txheem lis dej num nyob rau hauv lub 3 xyoo ua ntej pub dawb uas cov validations raug nthuav tawm nyob rau hauv Ntxiv Table S1, qhov twg muaj.

Cov ntaub ntawv tau nthuav tawm raws li qhov nruab nrab [interquartile range] lossis suav (feem pua). Lub sij hawm ntawm kev sib koom ua ke ( hnub ntsuas) yog hnub nephrectomy rau cov neeg pub dawb thiab tau muab tso rau cov tsis pub pub dawb.

poj niam. Raws li kev cia siab, nyobraumCov neeg pub dawb tau mus ntsib kws kho mob ntau dua hauv lub xyoo ua ntej hnub ntsuas piv rau cov neeg tsis pub pub dawb, yuav muaj feem cuam tshuam nrog lawv cov txheej txheem ntsuas (11 vs. 2). Qhov nruab nrab qhov nyiaj pub dawb tau kwv yees GFR (eGFR) yog 100 ml / min ib 1.73 m2 (IQR, 88– 112), thiab 12 feem pua ​​​​ntawm cov neeg pub dawb muaj ntshav siab ua ntej.

Qhov nruab nrab ntawm kev soj ntsuam yog 6.6 xyoo (IQR, 3.4– 10.4) rau cov neeg pub dawb thiab 6.8 xyoo (IQR, 3.8– 10.7) rau cov neeg tsis pub pub dawb, nrog rau kev soj ntsuam siab tshaj plaws ua 14,7y. Thaum kawg ntawm kev soj ntsuam xyuas (Lub Peb Hlis 31, 2017), lub sij hawm soj ntsuam tau raug censored rau cov laj thawj hauv qab no: 6 (1.0 feem pua) cov neeg pub dawb thiab 31 (1.3 feem pua ​​) cov neeg tsis pub dawb thaum lub sijhawm tuag, 0 (0 feem pua ​​) cov neeg pub dawb, thiab 3 (0.1 feem pua) cov neeg tsis pub dawb thaum lub sijhawm tsim cov kab mob raum kawg, thiab 21 (3.5 feem pua) cov neeg pub dawb thiab 20 (0.8 feem pua) cov neeg tsis pub dawb thaum lub sijhawm lawv tsiv tawm hauv lub xeev. Raws li qhov kawg ntawm kev ntsuas ntshav creatinine, feem ntau ntawm cov neeg pub dawb (60 feem pua) muaj eGFR ntawm 60 thiab 89 ml / min ib 1.73 m2, whereas 29 feem pua, 1.7 feem pua, thiab 0.2 feem pua ​​muaj eGFR ntawm 45– 59, 30. -44, thiab 15–29 ml / min rau 1.73 m2, raws li (Table 2).

Tus nqi hloov ntawm lub raum ua haujlwm

604 tus neeg mob lub raum nyob tau muaj tag nrho ntawm 7106 cov ntshav creatinine ntsuas tom qab hnub ntsuas, piv rau 15,970 ntshav creatinine ntsuas rau 2414 tsis pub dawb. Rau ob pawg, feem ntau cov kev ntsuas ntshav creatinine tau ua tiav hauv qhov chaw kho mob sab nraud (62 feem pua ​​​​rau cov neeg pub dawb thiab 76 feem pua ​​​​rau cov neeg tsis pub dawb). Txij li 6 lub lis piam mus, cov neeg pub nyiaj muaj qhov nruab nrab ntawm 7 (IQR, 3- 11) cov ntshav creatinine ntsuas piv rau 4 (IQR, 3-7) rau cov neeg tsis pub noj thaum taug qab. Lub sijhawm nruab nrab ntawm kev ntsuas yog 214 hnub (IQR, 133–359) rau cov neeg pub dawb piv rau 359 hnub (IQR, 183– 500). Tus naj npawb nruab nrab ntawm kev ntsuas ib xyoos yog 1.1 (IQR, 0.7– 1.6) rau cov neeg pub dawb thiab 0.8 (IQR, 0.5– 1.2) rau cov tsis pub dawb.

Qhov nruab nrab eGFRs ntawm ntau lub sijhawm, rau cov neeg pub dawb thiab cov neeg tsis pub dawb, tau nthuav tawm hauv daim duab 1, qhov nruab nrab eGFR qhov tseem ceeb tau nthuav tawm hauv Cov Lus Ntxiv S2. Zuag qhia tag nrho, eGFR qhov nruab nrab nce los ntawm þ0.35 ml / min ib 1.73 m2 toj xyoo (95 feem pua ​​​​kev ntseeg siab [CI], þ0.21 txog þ{{1{12} }}}.48) nyob rau hauv pub thiab txo los ntawm –{18}}.85 ml/min/1.73 m2 toj xyoo (95 feem pua ​​CI, –{{20}}.94 rau –0.75) nyob rau hauv tsis pub dawb (P <0.001; table="" 3).="" raws="" li="" tus="" qauv="" linear="" spline,="" qhov="" nruab="" nrab="" hloov="" pauv="" hauv="" egfr="" ntawm="" 6="" lub="" lis="" piam="" mus=""><2 years,="" 2="" to=""><5 years,="" and="" $5="" years="" onward="" in="" donors="" was="" þ1.06="" (95%="" ci,="" þ0.41="" to="" þ1.72),="" þ0.64="" (95%="" ci,="" þ0.30="" to="" þ0.98),="" and="" –0.06="" (95%="" ci,="" –0.31="" to="" þ0.19)="" ml/min="" per="" 1.73="" m2="" per="" year,="" respectively.="" among="" nondonors,="" the="" rate="" of="" change="" in="" egfr="" during="" these="" periods="" did="" not="" differ="" substantially="" and="" remained="" consistently="" negative="" over="" time="" (table="">

Tab 2|eGFR (ml / min ib 1.73 m2) qeb rau cov neeg pub dawb thiab kev tswj hwm tsis pub pub dawb raws li qhov kev ntsuas zaum kawg

Kev tsom xam pab pawg neeg pub dawb

The mean eGFR at various time points for the donor sub-group analyses are presented in Figure 2. The average pre-donation eGFR was higher in younger donors compared to older donors(115 ml/min per 1.73 m~ for donors aged 18-30 years vs.89 ml/min per 1.73 m²for donors aged>50 years; Table 4). Younger donors(18-30 years old)experienced a 33% decline in eGFR in the first 6 weeks after donation, compared to a 35%-37% decline in older donors. From 6 weeks onward, there was no significant difference in the average change in eGFR over time based on age category(P>0.05 rau kev xeem omnibus ntawm kev sib cuam tshuam cov ntsiab lus; Table 5).

Txawm hais tias qhov nyiaj pub dawb ua ntej eGFR zoo ib yam ntawm cov txiv neej thiab poj niam pub dawb (Table 4), qhov nce hauv eGFR lub sij hawm yog qhov nruab nrab ntawm cov txiv neej pub dawb piv rau cov poj niam pub dawb (ntxiv rau 0.56 vs. ntxiv rau {{4 }}.27 ml / min rau 1.73 m² ib xyoo; P=0.{{20}}45; Table 5). Cov neeg pub dawb uas muaj keeb kwm mob ntshav siab tau qis dua eGFR ua ntej pub dawb dua li cov neeg pub dawb uas tsis muaj ntshav siab (95 vs. 101 ml / min ib 1.73 m; P= 0.004; Table 4), tab sis qhov nruab nrab zoo sib xws tom qab pub dawb nce nyob rau hauv eGFR dhau sij hawm (ntxiv rau 0.48 vs. ntxiv rau 0.35 ml / min ib 1.73 m² ib xyoo; P=0.53; Table 5). Kuj tsis muaj qhov sib txawv tseem ceeb hauv kev hloov pauv hauv eGFR lub sijhawm raws li kev pub dawb

Table 3|Hloov hauv eGFR (ml/min ib 1.73 m² hauv ib xyoos) hauv cov neeg pub dawb thiab sib phim cov tswj tsis pub pub dawb los ntawm 6 wk mus rau

eGFR kwv yees glomerular filtration rate.

Tag nrho ntawm 38 tus neeg nyob hauv lub raum tsis muaj kev ntsuas ntshav creatinine tshaj li 6 wk tom qab pub dawb, yog li lawv cov kev tswj hwm tau raug cais tawm ntawm qhov kev tshuaj ntsuam no.

Kev hloov hauv eGFR yog nthuav tawm raws li qhov txhais tau tias (95 feem pua ​​​​ntawm kev ntseeg siab).

Cov txiaj ntsig tau los ntawm ob qho tib si thawj tus qauv (tag nrho, qhov twg qhov kev hloov pauv hauv eGFR dhau sijhawm yog sawv cev raws li ib qho kev nqes hav) thiab tus qauv thib ob (tus qauv linear spline, qhov twg qhov kev hloov pauv hauv eGFR lub sijhawm raug tso cai hloov).

Daim duab 2|Kwv yees glomerular filtration rate (eGFR in ml/min per 1.73 m2) nyob rau hauv cov neeg mob lub raum nyob rau hauv cov pab pawg neeg thaum lub sij hawm soj ntsuam: (a) hnub nyoog (yr); (b) poj niam txiv neej; (c) ua ntej pub nyiaj kub siab; (d) eGFR qeb ua ntej pub dawb (ml/min ib 1.73 m2); (e) eGFR txo (%) hauv thawj 6 lub lis piam; (f) eGFR qeb (ml/min ib 1.732) ntawm 1 xyoos; (txuas ntxiv)

eGFR category (P > 0.05 for omnibus test of interaction terms). The change in eGFR over time was modified by the initial percent decline in baseline eGFR within the first 6 weeks (P < 0.05 for the omnibus test of interaction terms). Donors who experienced a >40 feem pua ​​​​kev poob qis hauv lub hauv paus eGFR tom qab pub dawb ntawm qhov nruab nrab muaj tsawg dua ntawm kev nce hauv eGFR nyob rau lub sijhawm piv rau cov neeg pub dawb uas tau ntsib #30 feem pua ​​poob ntawm lawv cov hauv paus eGFR, txawm tias cov txiaj ntsig tsis ncav cuag statistical significance (þ0.47 vs. þ0.78 ml/min ib 1.73 m2 toj xyoo; P ¼ 0.33; Table 5). Txawm hais tias eGFR dhau sijhawm

Daim duab 2|(txuas ntxiv) (g) kev lag luam hauv zej zog; thiab (h) nrug mus rau qhov chaw hloov pauv (km).

nce rau cov neeg pub dawb hauv qis eGFR pawg ntawm 1 xyoo (60–79 lossis<60 ml/min="" per="" 1.73="" m2),="" egfr="" over="" time="" in="" donors="" in="" the="" upper="" egfr="" categories="" at="" 1="" year="" (80–89="" or="" $90="" ml/min="" per="" 1.73="" m="" )="" did="" not="" signi2="" ficantly="" change="" (þ0.09="" and="" –0.46="" ml/min="" per="" 1.73="" m2="" per="" year,="" respectively).="" the="" change="" in="" egfr="" over="" time="" was="" significantly="" different="" in="" donors="" with="" an="" egfr="" $90="" ml/min="" per="" 1.73="" m2="" at="" 1-year="" post-donation="" versus="" donors="" in="" each="" of="" the="" lower="" 2="" categories="" (p="" ¼="" 0.005="" for="" egfr="" 60–79="" ml/min="" per="" 1.73="" m2="" and="" p="" ¼="" 0.001="" for="" egfr=""><60 ml/min="" per="" 1.73="" m2,="" respectively;="" table="" 5).="" the="" change="" in="" egfr="" over="" time="" was="" not="" modified="" by="" either="" income="" category="" or="" distance-to-transplant-center="" category="" (p="" >="" 0.05="" for="" an="" omnibus="" test="" of="" interaction="">

Kev sib tham

Hauv qhov kev tshawb nrhiav rov qab no, peb piav qhia txog qhov hloov pauv tom qab pub dawb hauv eGFR rau 604 nyob.raumCov neeg pub dawb piv nrog 2414 noj qab nyob zoo, sib koom ua ke tsis pub dawb hauv Alberta, Canada. Peb pom tias eGFR tau nce los ntawm þ0.35 ml / min ntawm 1.73 m2 ib xyoos ib xyoos los ntawm 6 lub lis piam tom qab pub dawb. Qhov kev tshawb nrhiav no yog qhov sib piv rau cov neeg tsis pub pub dawb, uas tau pom qhov poob qis ntawm -0.85 ml / min ib 1.73 m2 toj xyoo. Lub raum them nyiaj hauv lub neejraumCov neeg pub dawb tau loj tshaj plaws hauv thawj 2 xyoos (þ1.06 ml / min ib 1.73 m2 toj xyoo) thiab pib toj siab los ntawm xyoo 5 (–0.06 ml / min ib 1.73 m2 toj xyoo). Kev hloov pauv hauv eGFR dhau sijhawm tom qab pub dawb sib txawv los ntawm kev sib deev, feem pua ​​​​ntawm eGFR poob qis hauv thawj 6 lub lis piam tom qab pub dawb, thiab eGFR qeb ntawm 1 xyoo, tab sis tsis yog qeb hnub nyoog ntawm kev pub dawb, kev pub dawb ua ntej, kev pub dawb eGFR qeb, kev lag luam hauv zej zog. raws li txoj cai, los yog nyob deb ntawm qhov chaw hloov pauv.

Txawm hais tias yav dhau los kev tshawb fawb tau pom tias muaj kev pheej hmoo ntawmraumkev ua tsis tiav yog qis dua hauv kev ua neej nyobraumCov neeg pub dawb tshaj li cov pej xeem, 12, 13 2 cov kev tshawb fawb los ntawm Norway thiab Asmeskas qhia tias qhov kev pheej hmoo siab dua rau cov neeg tsis muaj kev noj qab haus huv (kev pheej hmoo txaus ntshai tau tshaj tawm tias yog<1% over="" 15="" years="" for="" most="" donors).14–16="" given="" that="" kidney="" failure="" is="" rare="" in="" this="" unique="" patient="" population="" and="" long-term="" follow-up="" of="" healthy="" donors="" is="" difficult="" to="" achieve,17–19="" most="" studies="" rely="" on="" the="" nationwide="" administrative="" data="" to="" ascertain="" clinical="" outcomes="" related="" to="" renal="" replacement="" therapies,="" such="" as="" dialysis="" or="" transplant.20="" these="" databases="" often="" lack="" comprehensive="" laboratory="" data="" to="" describe="" the="" trends="" in="" post-donation="" egfr="" leading="" up="" to="" adverse="" events.="" one="" study="" from="" japan="" has="" reported="" the="" clinical="" course="" toward="" kidney="" failure="" for="" 8="" living="" kidneys="" donors="" at="" their="" transplant="" center.21="" generally,="" the="" donors="" in="" this="" study="" had="" stable="">lub raum ua haujlwmtom qab pub dawb nephrectomy, tab sis lawv tau tsim qhov poob qis tom qab "thib ob," xws li kub siab lossis proteinuria. Kev tshawb fawb tsis ntev los no los ntawm ib lub chaw hauv Asmeskas pom tias 39 ntawm 4030 nyobraumCov neeg pub nyiaj tsim lub raum tsis ua haujlwm hauv kev soj ntsuam, thiab 22 ntawm lawv tau ntsuas eGFR txaus los piav txog txoj kab nqes dhau lub sijhawm.22 Zoo ib yam li cov txiaj ntsig ntawm kev kawm dhau los, cov neeg pub dawb uas tsimraumKev ua tsis tiav tau hloov pauv ntawm txoj kab nqes ntawm eGFR tom qab kev txhim kho tus kab mob tshiab. Hauv peb txoj kev tshawb fawb, peb tsis tau piav qhia txog qhov cuam tshuam ntawm cov teeb meem tom qab pub dawb, xws li kev mob ntshav siab tshiab lossis proteinuria, ntawm qhov kev hloov pauv tom ntej hauv eGFR lub sijhawm, vim qhov no dhau ntawm qhov peb txoj kev kawm.

Peb cov txiaj ntsig tau zoo ib yam nrog kev kawm yav tom ntej los ntawm Kasiske li al. qhia tias qhov kev hloov pauv hauv eGFR lub sijhawm dhau los yog qhov sib txawv ntawm cov neeg pub dawb thiab cov neeg tsis noj qab haus huv.2 Peb txuas ntxiv mus rau cov kev tshawb pom no, nrog cov pab pawg loj dua (604 vs. 182), lub sijhawm ua raws ntev dua (7 xyoo vs. 3 xyoo), thiab suav nrog tag nrho cov kev ntsuas eGFR hauv lub xeev (qhov nruab nrab 7 qhov kev ntsuas rau cov neeg pub dawb hauv peb txoj kev tshawb fawb piv rau qhov siab tshaj 4 qhov kev ntsuas hauv qhov kev kawm yav tom ntej los ntawm Kasiske li al.). txheeb xyuas qhov hloov pauv hauv eGFR ntau lub sijhawm tom qab pub dawb (6 lub lis piam mus rau<2 years,="" 2="" to=""><5 years,="" and="" $5="" years)="" and="" show="" that="" the="" increase="">lub raum ua haujlwmntawm lub raum seem pib rau toj siab tom qab 5 xyoos. Cov txiaj ntsig zoo sib xws tau tshwm sim hauv ib qho kev tshawb fawb hauv ib lub chaw los ntawm Tel Aviv cuam tshuam nrog 211 nyob.raumpub dawb thiab 211 matched noj qab nyob zoo

eGFR kwv yees glomerular pom tus nqi: N / A, tsis muaj / siv tau,

Cov ntaub ntawv raug nthuav tawm raws li txhais tau tias ± SD. Txhais tau tias eGFR (raws li Kab Mob Raum Kab Mob- Kab Mob Sib Kis Sib Txuas Sib Txuas) tau suav nrog kev ntsuas tsis ntev los no hauv 1 xyoo ua ntej rau kev tso tawm, thiab tag nrho cov kev ntsuas (xws li, tus neeg mob hauv tsev kho mob, tus neeg mob sab nraud, lossis chav kho mob xwm txheej ceev) ± 3 wk rau 6 wk, thiab ± 6 hli rau 1, 2, 4, 6, 8, thiab 10 xyoo.

nondonor tswj nrog lub sijhawm ua raws li lub sijhawm ntawm 5.5 xyoo.23 Hauv qhov kev tshawb fawb ntawd, eGFR txoj kab nqes tau zoo nyob rau thawj 3 xyoo tom qab pub dawb, thiab tom qab ntawd tsis zoo nyob rau 3- 10 xyoo tom qab pub dawb.23 Kev soj ntsuam ntev dua. yuav tsum tau txiav txim siab seb qhov kev hloov pauv hauv eGFR puas tseem poob qis rau cov neeg pub dawb mus rau theem ntawm cov hnub nyoog poob qis hauv cov pej xeem. ntawm GFR dhau lub sij hawm tom qab thawj zaug them nyiaj, piv rau cov pej xeem.26

An important aspect of our study was the ability to compare changes in eGFR over time in various subgroups of donors. Overall, the increase in eGFR overtime on average was lower in female donors, in donors who had a >40 feem pua ​​(vs. #30 feem pua) poob qis hauv thawj 6 lub lis piam tom qab pub dawb piv rau tus nqi pub dawb ua ntej, thiab hauv cov neeg pub dawb nrog eGFR $90 ml/min ib 1.73 m2 ntawm 1-xyoo tom qab pub dawb (vs .

Raum International (2020) 98, 176–186

60–79 ib<60 ml/min="" per="" 1.73="" m2).="" we="" acknowledge="" that="" change="" in="" egfr="" remains="" an="" outcome="" that="" does="" not="" directly="" impact="" how="" a="" person="" feels="" or="" functions,="" and="" in="" another="" study,="" every="" 10="" ml/min="" per="" 1.73="" m2="" reduction="" in="" egfr="" 6="" months="" after="" a="" donation="" was="" associated="" with="" a="" 28%="" higher="" risk="" of="" kidney="" failure="" after="" adjusting="" for="" other="" baseline="" factors.27="" despite="" a="" lower="" post-donation="" increase="" in="" egfr="" in="" females="" in="" our="" study,="" in="" predictive="" risk="" models,="" the="" projected="" incidence="" of="" kidney="" failure="" in="" female="" donors="" is="" lower="" than="" that="" in="" male="" donors.28="" there="" is="" conflicting="" evidence="" to="" support="" ex-="" planations="" for="" this="" paradoxical="" finding,="" including="" lifestyle="" and="" biological="" factors="" that="" may="" influence="" gfr="" decline,="" along="" with="" nonbiological="" factors,="" such="" as="" the="" use="" of="" preventative="" healthcare,="" that="" may="" influence="" renal="" replacement="" therapy="">

Hauv peb txoj kev tshawb fawb, txoj hauv kev ntawm eGFR lub sijhawm dhau los tsis txawv qhov tseem ceeb ntawm cov hnub nyoog ntawm kev pub dawb, ua ntej pub nyiaj kub siab, ua ntej pub dawb eGFR qeb, kev lag luam hauv zej zog.

raws li txoj cai, los yog nyob deb ntawm qhov chaw hloov pauv. Raws li nyob rau hauv txoj kev tshawb fawb los ntawm Kasiske li al., qhov nruab nrab nce ntawm eGFR tus nqi tom qab pub dawb tsis tau ntau dua nyob rau hauv cov hluas piv rau cov laus pub. GFR.30,31 Hauv qhov sib piv, ib qho piv txwv ntawm qhov kev pheej hmoo pheej hmoo qhia tau tias cov kab mob ntshav siab hauv qab, raws li cov ntshav siab systolic lossis kev siv cov tshuaj tiv thaiv hypertensive, ua rau muaj qhov tshwm sim ntawm lub raum tsis ua haujlwm rau cov neeg nyob hauv lub raum pub dawb, txawm tias tsis pub dawb.32

Muaj kev txwv tsim nyog sau cia. Qhov no yog kev rov qab los, kev soj ntsuam kev tshawb fawb, thiab qhov muaj peev xwm ntawm kev xaiv tsis ncaj ncees thiab qhov seem seem yuav tsum tau txiav txim siab. Piv txwv li, peb txoj kev tshawb fawb tau txwv rau cov neeg uas xav tau qhov tsawg kawg nkaus ntawm cov ntshav creatinine kev ntsuas hauv kev soj ntsuam, uas tej zaum yuav tsis suav nrog cov neeg uas xav tias lawv tau txiav txim siab rov qab ntsuas tsis tsim nyog thiab cov neeg tuag. Txawm li cas los xij, tus lej raug tshem tawm los ntawm kev tshuaj xyuas vim tsis muaj kev ntsuas kev soj ntsuam me me (tsuas yog 6 tus neeg). Peb tsis muaj cov ntaub ntawv hais txog qee qhov hauv paus thiab cov yam ntxwv ntawm kev hloov pauv, xws li keeb kwm kev haus luam yeeb, tsev neeg keeb kwm ntawm lub raum kab mob, kev tswj ntshav siab, kev siv tshuaj, thiab lub cev qhov hnyav (piv txwv li, qhov siab thiab qhov hnyav), uas tej zaum yuav cuam tshuam rau kev loj hlob. ntawm lub raum poob. Txawm hais tias peb muaj cov ntaub ntawv nthuav dav ntawm txhua qhov kev ntsuas ntshav creatinine ua tiav hauv cov neeg mob sab nraud, tus neeg mob hauv tsev kho mob, thiab chav kho mob xwm txheej ceev, peb tsis muaj cystatin C ntsuas lossis ntsuas GFR raws li 24- teev creatinine

clearances lossis nuclear tshuaj scans. Ib txoj kev tshawb fawb ntawm 51 tus neeg mob raum nyob hauv University of Alberta pom tias cystatin C tsis muaj txiaj ntsig zoo txog kev saib xyuas tom qab pub dawb hauv thawj xyoo piv rau lwm yam kev ntsuas ntawm lub raum ua haujlwm.3 Lub raum Kab Mob: Txhim Kho Ntiaj Teb Cov txiaj ntsig kev soj ntsuam thiab Kev Saib Xyuas Ntawm Lub Rau Hli Cov Neeg Pab Tswv Yim pom zoo tias txhua xyoo tom qab pub dawb eGFR yuav tsum ua raws li qib creatinine hauv cov ntshav, vim lwm txoj hauv kev rau kev txiav txim siab GFR muaj tsawg tsawg (cystatin C) lossis tsis siv tau thiab kim rau kev soj ntsuam niaj hnub.24,33 Ntxiv rau, peb tau Tsis muaj peev xwm txheeb xyuas qhov qhia tau rau kev ntsuas ntshav creatinine kom sib txawv ntawm lub raum kev ua haujlwm ntawm lub raum saib xyuas thiab kev mob nkeeg lossis kev txhawj xeeb. Txawm li cas los xij, feem ntau ntawm kev ntsuas ntshav creatinine tau ua tiav hauv qhov chaw kho mob sab nraud. Txawm hais tias Kab Mob Raum: Txhim Kho Cov Txheej Txheem Ntiaj Teb Cov Lus Qhia pom zoo txhua xyoo kev soj ntsuam ntawm lub raum kev noj qab haus huv, suav nrog kev ntsuas ntshav creatinine, peb txoj kev tshawb fawb dhau los qhia tias qhov no tsis tau ua tas li rau feem coob ntawm cov neeg mob raum nyob hauv Alberta, Canada.34 Tsis tas li, kev saib xyuas niaj hnub ntawm Serum creatinine thiab albuminuria nyob rau hauv feem ntau, cov pej xeem tsis pub dawb tsis pom zoo, ua rau muaj kev soj ntsuam lossis cov ntaub ntawv tsis txaus ntseeg hauv peb txoj kev tshawb fawb. Qhov kev tsis ncaj ncees no yuav piav qhia txog qhov feem ntau ntawm cov neeg tsis pub dawb uas tsis muaj cov tshuaj creatinine los yog albuminuria kuaj hauv lub xyoo ua ntej nkag mus rau hauv pawg. Muaj tseeb tiag, qhov nruab nrab qhov nruab nrab ntawm eGFR poob qis hauv cov neeg tsis pub dawb hauv qhov kev tshawb fawb no tau zoo ib yam li cov ntawv tshaj tawm dhau los ntawm cov hnub nyoog ntsig txog kev poob qis hauv cov pej xeem.2,24,25 Thaum kawg, peb cov txiaj ntsig yuav tsis tuaj yeem nthuav dav rau cov neeg pub dawb hauv lwm lub tebchaws uas tsis muaj kev kho mob thoob ntiaj teb zoo sib xws.

In our study, we demonstrate that the average change in eGFR over time is significantly different between donors and non-donors and that the initial increase in eGFR on average after donor nephrectomy (which we attribute to compensatory hypertrophy) begins to plateau by 5 years post-donation. Although certain donor subgroups had on average lower eGFR values in follow-up, it is reassuring that the mean eGFR was >60 ml / min ib 1.73 m2 rau yuav luag tag nrho cov pab pawg, ntawm txhua lub sijhawm ntsuas tom qab pub dawb, rau peb lub sijhawm ua raws 10 xyoo. Cov kev tshawb fawb ntxiv nrog rau kev soj ntsuam ntev dua yog xav tau los txiav txim seb qhov kev hloov pauv thawj zaug hauv eGFR nyob rau xyoo caum thawj puas cuam tshuam nrog cov txiaj ntsig tsis zoo tom qab pub dawb.

Txoj kev

Tsim thiab teeb tsa

Peb tau ua ib txoj kev tshawb fawb txog pej xeem, rov qab los ntawm kev siv cov ntaub ntawv kho mob sib txuas hauv AlbertaLub raumKab Mob Network.9 Tshaj li 99 feem pua ​​​​ntawm cov neeg nyob hauv Alberta tau sau npe nrog Alberta Health thiab muaj kev nkag mus rau kev saib xyuas hauv tsev kho mob thiab cov kws kho mob. Peb tau ua raws li cov lus qhia rau kev tshaj tawm cov kev tshawb fawb soj ntsuam (Table Ntxiv S3) 35 thiab cov txheej txheem pom zoo los ntawm pawg thawj coj saib xyuas kev ncaj ncees ntawm University of Alberta thiab University of Calgary, nrog rau kev zam ntawm tus neeg mob tso cai.

Cov ntaub ntawv

Peb tau txheeb xyuas cov yam ntxwv hauv paus, cov ntaub ntawv sib txawv, thiab cov ntaub ntawv tshwm sim los ntawm AlbertaLub raumKab mob Network cov ntaub ntawv khaws tseg (Table Ntxiv S1). Alberta Health database muaj cov ntaub ntawv qhia txog pej xeem, cov txheeb cais tseem ceeb, thiab cov ntaub ntawv kuaj mob thiab cov txheej txheem rau cov kws kho mob sab hauv thiab sab nraud. Peb txuas cov ntaub ntawv no mus rau lub chaw kuaj mob hauv lub xeev los ntawm qhov tshwj xeeb, encoded, tus neeg mob tus cim. Cov kev ntsuas cov ntshav creatinine tau txais hauv peb cov ntaub ntawv tau raug ntsuas thoob plaws hauv lub xeev lub chaw soj nstuam dhau sijhawm, txo qis kev sib txawv ntawm chav kuaj hauv kev ntsuas.9 Cov ntaub ntawv no tau siv yav dhau los rau kev tshawb fawb txog kev noj qab haus huv thiab kev pabcuam.34,36–38

Cov pejxeem

Nyobraumpub dawb. Peb tau txheeb xyuas tag nrho cov neeg laus nyob hauv lub raum pub dawb ($ 18 xyoo) uas tau txais kev kho mob nephrectomy thaum lub Tsib Hlis 1, 2002, thiab Kaum Ob Hlis 31, 2016, hauv Alberta, Canada (Cov Duab Ntxiv S1). Cov neeg nyob hauv lub raum tau raug txheeb xyuas los ntawm kev siv cov txheej txheem uas yuav tsum muaj 1 qhov kev kuaj mob rau lub raum pub dawb (International Statistical Classifications of Diseases and Related Health Problems, 10th Revision [ICD-10]: Z52.4) and 1 procedural code for Kev muab lub raum los yog kev txiav tawm (Canadian Classification of Health Interventions, CCI: 1.PC.58, 1.PC.89, lossis 1.PC.91; Supplementary Table S1). Cov lej zoo sib xws tau raug siv hauv cov kev tshawb fawb ua ntej los txheeb xyuas cov neeg nyob hauv lub raum.34,39–41 Peb tau lees paub cov txheej txheem no thiab pom tias nws muaj qhov rhiab heev ntawm 97 feem pua ​​​​thiab qhov zoo kwv yees tus nqi ntawm 90 feem pua, piv nrog cov qauv kub ntawm kev ua neej nyob.raumKev txheeb xyuas tus neeg pub dawb los ntawm lub xeev cov ntaub so ntswg thiab cov khoom nruab nrog cev, thiab kev txheeb xyuas los ntawm phau ntawv qhia kev ua haujlwm ntawm daim ntawv qhia rov qab saib.42 Hnub tim ntawm nephrectomy tau ua hnub pib rau kev soj ntsuam (hnub ntsuas). Peb tsis suav cov neeg pub dawb tawm hauv lub xeev thiab ib feem me me ntawm cov neeg pub dawb (<3%) with="" missing="" data="" (e.g.,="" sex="" or="" date="" of="" birth).="" to="" avoid="" misclassification="" of="" kidney="" transplant="" recipients,="" we="" excluded="" anyone="" with="" evidence="" of="" prior="" dialysis,="" transplant,="" or="" an="" egfr=""><60 ml/min="" per="" 1.73="" m2="" in="" the="" year="" before="" the="" index="" date.="" we="" excluded="" donors="" who="" did="" not="" have="" an="" outpatient="" egfr="" measurement="" recorded="" in="" our="" data="" sources="" in="" the="" year="" before="" donation.="" lastly,="" we="" excluded="" donors="" who="" had="" fewer="" than="" 3="" serum="" creatinine="" measurements="" (inpatient,="" outpatient,="" or="" emergency="" room)="" during="" follow-up="" (only="" 6="" donors="" were="" excluded="" for="" this="" reason).="" to="" monitor="" kidney="" health,="" it="" is="" recommended="" that="" donors="" have="" their="" serum="" creatinine="" level="" measured="" each="" year="" after="">

Nondonor tswj. NyobraumCov neeg pub nyiaj tau txais kev soj ntsuam nruj thiab xaiv cov txheej txheem thiab yog li ntawd muaj kev noj qab haus huv zoo dua li cov pej xeem. Txhawm rau txhim kho kev sib piv, peb siv cov txheej txheem ntawm kev txwv thiab kev sib txuam los xaiv cov kab noj qab haus huv tshaj plaws ntawm cov pej xeem. Ua ntej, peb random muab lub hnub ntsuas (simulated nephrectomy hnub) rau tag nrho Alberta cov pejxeem raws li kev faib cov hnub ntsuas hauv cov neeg pub dawb (2002 txog 2016). Tom qab ntawd, peb tau txheeb xyuas qhov sib txawv ntawm lub Plaub Hlis 1, 1994 (thaum pib ntawm cov ntaub ntawv muaj nyob) mus rau hnub ntsuas.

Peb txwv tsis pub cov qauv ntawm cov neeg tsis muaj cai tsim nyog rau cov uas tsis paub txog kev mob nkeeg lossis kev kuaj sim ua ntej kev nkag mus hauv pawg neeg uas tuaj yeem txwv tsis pub pub dawb, suav nrog ntshav qab zib mellitus, eGFR<60 ml/min="" per="" 1.73="" m,="" or="" signi2="" ficant="" albuminuria.="" furthermore,="" we="" excluded="" anyone="" who="" had="" evidence="" of="" frequent="" physician="" visits="" (="">4 mus ntsib hauv 2 xyoo dhau los) lossis leej twg tsis pom tus kws kho mob tsawg kawg ib zaug hauv 2 xyoo dhau los, kom ntseeg tau tias lawv tau nkag mus rau cov kws kho mob rau cov kev xav tau kev noj qab haus huv niaj hnub. Peb cais cov tsis pub dawb

uas tau dhau qhov tsawg kawg nkaus thiab siab tshaj hnub nyoog ntawm cov neeg pub dawb ntawm lawv cov hnub ntsuas. Peb kuj tsis suav cov neeg tsis pub dawb uas muaj tsawg dua 3 qhov kev ntsuas ntshav creatinine thaum ua raws. Los ntawm tag nrho ntawm 4,906,314 tus neeg nyob hauv Alberta, peb tsis suav nrog 99 feem pua ​​​​ntawm cov neeg laus (n ¼ 4,863,599). Tom qab ntawd peb tau sib tw 4 tus neeg muaj cai noj qab haus huv tsis pub dawb rau txhua tus neeg pub dawb raws li hnub nyoog (5 xyoos), poj niam txiv neej, hnub ntsuas (1 xyoos), chaw nyob hauv nroog, thiab cov neeg mob sab nraud eGFR tsis ntev los no ua ntej hnub ntsuas (5 ml / min ib 1.73 m2, nyob rau hauv lub xyoo dhau los rau cov neeg pub dawb thiab nyob rau hauv 3 xyoo ua ntej rau cov tsis pub dawb). Rau cov neeg pub dawb uas muaj tsawg dua 4 tus neeg tsis muaj kev noj qab haus huv zoo sib xws, rov qab so ntawm qhov tseeb ntawm hnub nyoog thiab qhov ntsuas hnub sib piv qhov rais tau ua kom muaj kev sib txuam ntawm 4 cov neeg tsis noj qab haus huv. Tom qab cov txheej txheem sib txuam, tsuas yog 2 tus neeg pub dawb muaj tsawg dua 4 tus neeg koom nrog kev noj qab haus huv tsis pub dawb (Cov duab ntxiv S1).

Cov yam ntxwv ntawm lub hauv paus

Cov pej xeem hauv paus tau txiav txim siab los ntawm Alberta Health cov ntaub ntawv tswj xyuas cov ntaub ntawv. Postal codes tau txuas nrog Canadian Census siv cov ntaub ntawv Postal Code hloov dua siab tshiab los txiav txim qhov nruab nrab ntawm cov tsev neeg cov nyiaj tau los hauv zej zog quintile (theem 5 yog qhov siab tshaj) nrog rau cov neeg nyob deb nroog ntawm qhov chaw nyob thiab nyob deb ntawm qhov chaw hloov pauv, raws li tau piav qhia yav dhau los.43 -45 Lub xub ntiag ntawm 1 lossis ntau dua cov lej kuaj mob hauv 3 xyoos ua ntej hnub ntsuas tau siv los txheeb xyuas cov kab mob sib kis uas siv tau siv tau ICD, Ninth Revision, Clinical Modification (ICD-9-CM), thiab ICD-10 coding algorithms siv rau cov kws kho mob thov thiab cov ntaub ntawv kho mob hauv tsev kho mob.46–50 Cov ntaub ntawv pej xeem tau ua tiav tshwj tsis yog cov nyiaj tau los quintile (<2% missing)="" and="" distance="" to="" the="" transplant="" center=""><0.5% missing).="" although="" we="" excluded="" those="" with="" missing="" data="" from="" the="" modeling="" analyses,="" results="" were="" not="" significantly="" different="" when="" we="" imputed="" missing="" income="" quintile="" as="" middle="" income="" (level="" ¼="" 3)="" or="" missing="" distance="" from="" the="" transplant="" center="" as=""><50>

Cov txiaj ntsig

Thawj qhov tshwm sim yog qhov hloov pauv hauv eGFR lub sijhawm (hauv ml / min ib 1.73 m2 ib xyoos twg) rau cov neeg pub dawb thiab cov neeg tsis pub dawb uas siv tag nrho cov kev ntsuas eGFR los ntawm 6 lub lis piam tom qab hnub ntsuas ntawm onward.51–53

eGFR tau kwv yees siv ChronicLub raumKab Mob- Kab Mob Sib Kis Sib Koom Tes (CKD-EPI) equation.54 Txawm hais tias cov ntaub ntawv hais txog haiv neeg tsis muaj, kev cais ntawm eGFR yuav tsum tsis tshua muaj vim tias w3 feem pua ​​​​ntawm Alberta cov pej xeem yog cov dub.55 Peb tau soj ntsuam ntxiv los tshuaj xyuas qhov cuam tshuam ntawm ntau yam ntxwv. ntawm kev nce qib ntawm eGFR dhau lub sijhawm hauv kev ua neej nyobraumcov neeg pub dawb, suav nrog hnub nyoog thaum lub sijhawm koom nrog pawg, poj niam txiv neej, thiab qeb eGFR predo-nation.

Kev txheeb cais

Cov neeg pub dawb thiab cov neeg tsis pub pub dawb tau ua raws li lawv cov hnub ntsuas ntsuas kom txog rau thaum

first of either death, development of end-stage kidney disease (defined as the receipt of chronic dialysis or a kidney transplant), emigration from the province, or end of the study period (March 31, 2017). We compared baseline characteristics between donors and matched nondonors using standardized differences, where a standardized difference of >10 feem pua ​​​​hais txog qhov tsis txaus ntseeg.56 Peb

modeled the change in eGFR over time using linear mixed-effects models. Estimated GFR measurements in the first 6 weeks of the index date were excluded. In the primary model, we included fixed effects for exposure (i.e., donors and nondonors), the timing of eGFR measurement, and their interaction. This model restricted the eGFR slope to remain the same over time. In a secondary model, we used a linear spline to allow the eGFR slope to change over time. We selected clinically meaningful knots at 2 and 5 years. For both the primary and secondary models, we included a random, individual- specific intercept and slope with an unstructured covariance between the random effects to account for correlation among measurements within the same individual. We also included a random effect for the matched group. Subgroup analyses were performed in donors only and included stratification by age categories at donation (18–30 years, 31–40 years, 41–50 years, >50 xyoo;

vim tias txhua xyoo tus nqi ntawm eGFR poob qis dua hauv cov neeg laus laus25), kev sib deev (vim tias eGFR poob qis tuaj yeem nrawm dua hauv cov txiv neej29), kev pub dawb ua ntej kub siab (vim tias ntshav siab tuaj yeem nrawm dua.raumkab mob kev loj hlob 57), ua ntej pub dawb eGFR pawg (<80, 80–89,="" $90="" ml/min="" per="" 1.73="" m2;="" because="" lower="" egfr="" category="" may="" be="" associated="" with="" more-rapid="" renal="" decline58),="" egfr="" reduction="" in="" the="" first="" 6="" weeks="" (#30%,="" 31%–40%,="">40 feem pua; vim tias qhov kev txo qis ntau dua hauv eGFR tuaj yeem cuam tshuam nrog lub raum tsis zoo59), eGFR qeb ntawm 1 xyoo ($ 90, 80–89, 60–79,<60 ml/min="" per="" 1.73="" m2),="" income="" quintiles,="" and="" distance="" to="" transplant="" center=""><50, 50.1–="" 150,="" 150.1–300,="">300 km). Peb npaj eGFR dhau lub sijhawm siv kev ntsuas uas nyob hauv 3 lub lis piam rau 6-lub limtiam lub sijhawm taw qhia thiab hauv 6 lub hlis rau cov sijhawm ntxiv (xyoo 1, 2, thiab tom qab ntawd biannally txog xyoo 10 tom qab pub dawb). P-tus nqi ntawm<0.05 was="" used="" to="" define="" statistical="" significance.="" statistical="" analyses="" were="" performed="" using="" stata="" mp="" 13.1="" (stata="" corporation,="" college="" station,="">

Qhia tawm

Txhua tus kws sau ntawv tshaj tawm tsis muaj kev sib tw txaus siab.

TXOJ CAI

Txoj kev tshawb no yog nyob rau hauv ib feem ntawm cov ntaub ntawv muab los ntawm Alberta Health thiab Alberta Health Services. Cov kev txhais lus thiab cov lus xaus nyob rau hauv no yog cov neeg tshawb fawb thiab tsis tas yuav sawv cev rau cov kev xav ntawm tsoomfwv Alberta lossis Alberta Health Services. Tsoomfwv ntawm Alberta, Alberta Health, thiab Alberta Kev Pabcuam Kev Noj Qab Haus Huv tsis qhia tawm tswv yim txog qhov kev kawm no. Peb tsis muaj peev xwm ua kom peb cov ntaub ntawv muaj nyob rau lwm cov neeg tshawb fawb vim peb cov ntawv cog lus nrog lub xeev lub chaw saib xyuas kev noj qab haus huv (Alberta Health), uas yog tus saib xyuas cov ntaub ntawv. Cov kws tshawb fawb tuaj yeem thov kom tau txais cov ntaub ntawv zoo sib xws ntawm https://albertainnovates.ca/our-health- innovation-focus/the-Alberta-spor-support-unit/. Txoj kev tshawb no tau txhawb nqa los ntawm Canadian Institutes of Health Research (CIHR) Project

Nyiaj pab (391688). AXG tau txais kev txhawb nqa los ntawm Clinician Investigator Award los ntawm Canadian Institutes of Health Research thiab Dr. Adam Linton Chair hauvLub raumHealth Analytics. BRH tau txais kev txhawb nqa los ntawm Roy thiab Vi Baay Chair hauvLub raumKev tshawb fawb.

AUTHOR CONTRIBUTIONS

NNL, AL, thiab AXG tsim qhov kev kawm. AL tau ua cov ntaub ntawv txheeb xyuas thiab tsim cov duab. NNL tau tsim thiab kho cov ntawv. Txhua tus kws sau ntawv pom zoo rau qhov kawg ntawm cov ntawv sau.

SUPPLEMENTARY KHOOM

Cov ntaub ntawv ntxiv (PDF)

Daim duab S1. Cohort creation.

Tab S1. Databases thiab coding cov ntsiab lus rau kev suav nrog / cais tawm, cov yam ntxwv hauv paus, thiab ntsuas qhov tshwm sim. Tab S2. Median eGFR (ml / min ib 1.73 m2) nyob rau hauvraumcov neeg pub dawb thiab cov neeg tsis muaj mob noj qab haus huv thaum taug qab.

Tab S3. STROBE daim ntawv teev npe.

REFERENCES

1. Garg AX, Muirhead N, Knoll G, et al. Proteinuria thiab txo lub raum ua haujlwm hauv lub neejraumCov neeg pub dawb: kev tshuaj xyuas zoo, kev tshuaj xyuas meta, thiab meta-regression. Raum Int. 2006; 70:1801–1810.

2. Kasiske BL, Anderson-Haag T, Israni AK, et al. Txoj kev tshawb nrhiav yav tom ntej ntawm cov neeg mob lub raum ua neej nyob: kev soj ntsuam peb xyoos. Am J Raum Dis. 2015; 66:114–124.

3. Gourishankar S, Courtney M, Jhangri GS, et al. Serum cystatin C ua tau zoo ib yam li cov cim cim ntawmlub raum ua haujlwmnyob rau hauv kev ntsuam xyuas ntawm tus neeg pub dawblub raum ua haujlwmua ntej thiab tom qab unilateral nephrectomy. Nephrol Dial Hloov. 2008;23:3004-3009.31.Tent H, Sanders JSF, Rook M, et al. Cov teebmeem ntawm kev kub siab ua ntej ntawm cov ntshav siab thiab lub raum tsis ua haujlwm tom qab pub dawb nephrectomy. Kev hloov pauv. Xyoo 2012; 93: 412-417.

4.LIS. Huang YM.Wang M. et al. Kev tshuaj ntsuam meta-kev soj ntsuam ntawm lub raum cov txiaj ntsig hauv lub raum pub dawb, Tshuaj (Baltimore) 2016: 95: e3847.32. Grams ME, Sang Y, Levey AS, et al. Lub raum-ua tsis tau tejyam projection rau cov nyobraum-tus neeg sib tw pub dawb N Engl J Med, 2016; 374:411-421.

5. Waterman AD, Dew MA, Davis CL, et al. Kev ua neej nyob-pab saib xyuas tus cwj pwm thiab kev coj ua hauv Teb Chaws Asmeskas cov kev pab rau lub raum thiab lub siab pub dawb. Hloov J. 2013; 95:883-88.

6. Huang N, Foster MC, Lentine KL, et al. Kwv yees GFR rau kev nyobraumkev ntsuam xyuas pub dawb. Am JTransplant, 2016:16:171-180.

7. Levey AS, Inker LA. Kev ntsuas GFR nyob rau hauv cov neeg mob raum pub rau cov neeg sib tw. J Am Soc Nephrol. Xyoo 2017; 28:1062-1071.

8. Lamb EJ, MacKenzie F, Stevens PE. Yuav kuaj thiab ntsuas proteinuria li cas? Ann Clin Biochem. 2009:46:205-217.

9. Hemmelaarn BR Clement E, Manns BJ, et al, Overview of the Alberta Kidney Disease Network, BMC Nephrol, 2009; 1030.

10. Tonelli M, Muntner P, Lloyd A, et al. Kev cuam tshuam ntawm lub hnub nyoog ntawm kev koom tes ntawm CKD thiab kev pheej hmoo ntawm cov xwm txheej coronary yav tom ntej.Am JLub raumDis. Xyoo 2014; 64: 1-8.

11. Andrassy KM.Cov lus pom ntawm KDIGO 2012 cov lus qhia kev kho mob rau kev ntsuam xyuas thiab kev tswj cov kab mob raum ntev.' Raum Int. 201384: 622-623.

12. Fehrman-Ekholm I, Nordén G, Lennerling A, et al. Qhov tshwm sim ntawm cov kab mob raum kawg ntawm cov neeg mob raum nyob. Kev hloov pauv. 2006; 82:{5}}.

13. Cherikh WS, Young CJ, Kramer BF, et al. Kev sib txawv ntawm haiv neeg thiab poj niam txiv neej sib txawv ntawm qhov kev pheej hmoo ntawm cov kab mob raum kawg tom qab nyob rau lub raum pub dawb. Am J Transplant.2011;11:1650-1655.

14. Muzaale AD, Massie AB, Wang MC, et al. Kev pheej hmoo ntawm cov kab mob raum kawg tom qab pub raum nyob. JAMA.2014;311:579-586.

15. Mijoen G, Hallan S, Hartmann A, et al. Kev pheej hmoo mus sij hawm ntev rau cov neeg mob raum.Kidney Int. 2014;86:162-167.

16. Lam NN, Lentine KL, Garg AX.End-stage renal disease risk nyob rau hauv lub raum pub: Peb tau kawm dab tsi los ntawm ob qhov kev tshawb fawb tsis ntev los no? Curr Opin Nephrol Hypertens Cov. 2014:23592-596.

17. Leichtman A. Abecassis M, Barr M, et al. NyobraumKev ua raws li tus neeg pub dawb: lub xeev-ntawm-tus-kos duab thiab cov lus qhia yav tom ntej, cov ntsiab lus ntawm lub rooj sib tham, thiab cov lus pom zoo. Am / Hloov. 2011:11:2561-2568.

18. Henderson ML Thomas AG. Shaffer A. et al, Lub teb chaws toj roob hauv pes ntawm lub raum pub rau cov neeg nyob hauv lub tebchaws United States.Am J Transplant. Xyoo 2017; 17:3131-3140.

19. Schold JD, Buccini LD, Rodrigue JR, et al. Cov xwm txheej tseem ceeb cuam tshuam nrog cov ntaub ntawv rov qab uas ploj lawm rau cov neeg muaj lub raum nyob hauv Tebchaws Meskas.Am J Hloov. 2015; 15:2394-2403.

20. Lentine KL, Segev DL Kev nkag siab zoo dua nyob ntawm tus neeg pub nyiaj txaus ntshai los ntawm cov ntaub ntawv loj. Clin J Am Soc Nephrol. Xyoo 20138: 1645-1647.

21. Kido R, Shibagaki Y, lwadoh K, et al. Cov neeg mob lub raum ua neej nyob li cas thiaj tsim tau tus kab mob raum kawg? Kuv JTransplant. 2009; 9:2514-2519. 22. Matas AJ, Berglund DM, Vock DM, Ibrahim HN. Ua rau thiab lub sij hawm ntawm cov kab mob raum kawg tom qab lub raum pub dawb.Am J Hloov. 2018;18:1140-1150.

23. Grupper A Angel Y, Baruch A, thiab al. Lub sij hawm ntev metabolic thiab lub raum tshwm sim ntawm lub raum pub piv rau kev tswj nrog rau lub raum ua haujlwm zoo. BMC NPE. Xyoo 2019; 20:30.

24. Levin A, Stevens PE, Bilous RW, et al. Kab mob raum: Txhim kho Cov txiaj ntsig thoob ntiaj teb (KDIGO) CKD pawg ua haujlwm. KDGO 2012 cov lus qhia txog kev kho mob rau kev soj ntsuam thiab kev tswj cov kab mob raum ntev. Raum Int Suppl, 20133;1- 150.

25. Lindeman RD.Tobin J. Shock NW, Longitudinal studies on the rate of deficiency in renal function with age.JAm Geriatr Soc,198533278-285.

26. Fehrman-Ekholm I, Duner F, Brink B, et al. Tsis muaj pov thawj ntawm kev ua kom lub raum tsis ua haujlwm hauv lub raum muaj sia nyob: tau tshwm sim los ntawm kev ua raws li ntu ntu. Kev hloov pauv. 2001:72:444-449.

27. Massie AB, Holscher CM, Henderson ML, et al. Lub koom haum ntawm kev ua haujlwm pub dawb rau lub raum thaum ntxov nrog kev pheej hmoo ntawm cov kab mob raum kawg hauv cov neeg mob raum nyob.JAMA Surg. Xyoo 2020; 155:e195472.

28. Massie AB, Muzaale AD, Luo X, et al. Txheeb xyuas qhov kev pheej hmoo pub dawb tom qab ESRD hauv cov neeg mob raum nyob. J Am Soc Nephrol.2017;28:2749-2755.

29. Carrero JJ, Hecking M, Chesnaye NC, Jager KJ.Sex thiab poj niam txiv neej tsis sib xws hauv kev sib kis thiab tshwm sim ntawm cov kab mob raum ntev. Nat Rev Nephrol. 2018; 14:151-164.

30. Textor SC, Taler SJ, Driscoll N, thiab al. Ntshav siab thiab lub raum ua haujlwm tom qab lub raum pub dawb los ntawm cov neeg mob ntshav siab nyob. Kev hloov pauv. 2004; 78:276-282.

31. Tsev pheebsuab H, Sanders JSF, Rook M, thiab al.Cov teebmeem ntawm kev kub siab ua ntej ntawm

ntshav siab thiab residual lub raum ua haujlwm tom qab pub dawb nephrectomy. Transplantation.2012;93:412-417.

32. Grams ME, Sang Y, Levey AS, et al.Kidney-failure risk projection for the living raum-donor candidate. N Engl JMed.2016;374:411-421.

33. Lentine KLKasiske BL, Levey AS.et al. KDGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors.Transplantation. 2017;101:S1-S109.

34. Lam NN, Lentine KL, Hemmelgarn B, thiab al.Tom qab saib xyuas cov neeg mob raum nyob hauv Alberta, Canada. Can J Raum Kho Dis. Xyoo 2018; 5:1-11.

35. yon Elm E, Altman DG, Egger M, et al. Kev txhawb nqa kev tshaj tawm ntawm kev soj ntsuam kev tshawb fawb hauv epidemiology (STROBE) cov lus qhia rau kev tshaj tawm cov kev tshawb fawb soj ntsuam. J Clin Epidemiol. 2008; 61:344-349.

36. Hemmelgarn BR, Manns BJ, Lloyd A, et al. Kev sib raug zoo ntawmlub raum ua haujlwm, proteinuria, thiab qhov tshwm sim tsis zoo.JAMA.2010;303:423-429. 37, Lam NN, Tonelli

36. Hemmelgarn BR, Manns BJ, Lloyd A, et al. Kev sib raug zoo ntawm lub raum ua haujlwm, proteinuria, thiab cov txiaj ntsig tsis zoo. JAMA.2010;303:423-429.

37. Lam NN, Tonelli M, Lentin KL, et al. Albuminuria, thiab posttransplant mob raum kab mob theem kwv yees hloov cov txiaj ntsig. Raum Int. Xyoo 2017; 92: 470-478.

38. Lam NN, Klarenbach S, Quinn RR, et al. Lub raum ua haujlwm, albuminuria, thiab kev pheej hmoo ntawm cov kab mob plawv tom qab hloov lub raum. Hloov Direct.2018; 4:e389.

39. Schold JD, Goldfarb DA, Buccini LD, et al. Comorbidity lub nra thiab cov teeb meem perioperative rau cov neeg mob raum nyob hauv Tebchaws Meskas. Clin JAm Soc Nephrol, 2013:8;1773-1782.

40. Schold JD, Goldfarb DA, Buccini LD, et al. Kev mus pw hauv tsev kho mob tom qab muaj sia nyob pub nephrectomy hauv Tebchaws Meskas. Clin J Am Soc Nephrol.2014;9:355-365.

41. Lentine KL, Lam NN, Axelrod D, thiab al.Perioperative complications after living donation: a national study. AmJTransplant. 2016; 16:1848-1857.

42. Lam NN, Lentine KL, Klarenbach S, et al. Kev lees paub ntawm cov neeg pub nyiaj nephrectomy nyob. Can J Kidney Heal Dis.2018;5:1-9.

43. Tonelli M, Kallenbach S Manns B, et al.Residence qhov chaw thiab qhov yuav ua rau lub raum hloov pauv. CMA. 2006; 175478-482.

44. Tonelli M, Hemmelgarn B, Kim AK, et al. Kev sib koom ua ke ntawm qhov chaw nyob thiab qhov tshwm sim ntawm kev hloov lub raum hauv cov neeg mob Aboriginal kho nrog kev lim ntshav hauv Canada. Raum Int. 2006; 70:924-930.

45. Bello AK, Hemmelgarn B, Lin M, et al. Kev cuam tshuam ntawm qhov chaw nyob deb ntawm kev saib xyuas zoo thiab kev sib raug zoo rau cov txiaj ntsig kev noj qab haus huv hauv cov neeg mob ntshav qab zib thiab mob raum mob, Nephrol Dial Transplant.2012; 27:3849-3855.

46. ​​Quan H, Khan N, Hemmelgarn BR, et al. Kev lees paub ntawm cov ntaub ntawv txhais los txhais cov ntshav siab siv cov ntaub ntawv tswj hwm. Hypertension.2009;54:1423-1428.

47. Quan H, LiB, Duncan Saunders L, et al. Kev ntsuas qhov siv tau ntawm ICD-9-CM thiab ICD-10 cov ntaub ntawv tswj hwm hauv kev sau cov kev kho mob hauv cov ntaub ntawv tshwj xeeb dual coded. Health Serv Res.2008;43:1424-1441.

48. Gershon AS, Wang C, Guan J, et al. Txheeb xyuas cov neeg mob uas tus kws kho mob kuaj mob hawb pob hauv kev tswj hwm kev noj qab haus huv databases. Can Respir J.16:183-188

49. Tonelli M, Wiebe N, Fortin M, et al. Txoj hauv kev los txheeb xyuas 30 qhov mob ntev: daim ntawv thov rau cov ntaub ntawv tswj hwm.BMC Med Qhia Decis Mak. Peb 2015; 15:31.

50. Ouan H, Sundararajan V, Halfon P, et al. Coding algorithms rau kev txhais cov comorbidities hauv ICD-9-CM thiab ICD-10 cov ntaub ntawv tswj hwm. Med Care. 2005; 43:1130-1139.

51. Turin TC, Coresh J, Tonelli M, et al. Hloov hauv qhov kwv yees glomerular pom tus nqi dhau lub sijhawm thiab kev pheej hmoo ntawm txhua qhov ua rau tuag.Kidney Int.2013; 83:684-691.

52. Turin TC, Jun M, James MT, et al. Kev loj hlob ntawm tus nqi ntawm kev hloov hauv lub raum kev ua haujlwm thiab kev pheej hmoo ntawm kev mob plawv yav tom ntej. IntJ Cardiol.2016;202:657-665.

53. Turin TC, James M, Ravani P, et al. Proteinuria thiab tus nqi hloov pauv hauv lub raum ua haujlwm hauv cov neeg nyob hauv zej zog.JAm Soc Nephrol. 2013; 24:1661-1667.

54. Levey AS, Stevens LA, Schmid CH, et al. Ib qho kev sib npaug tshiab los kwv yees glomerular filtration rate. Ann Intern Med.2009; 150:604-612.

55. Kev txheeb cais Canada. Census Profile, 2016 Census.Available at:https://www12.statcan.gcca/census-recensement/2016/dp-pd/prof/details/page.cfm?Lang=E8Geo1=PR&Code 1=488Geo2=PR8Code2=01 &Data= suav&SearchText=alberta&SearchType=Bigins&SearchPR=01 &B1=Tag nrho&TABID{{ 18}}.Tau lub Cuaj Hlis 23, 2018.