Hloov kho mob raum kab mob sib kis kab mob sib koom ua ke sib npaug rau qhov kwv yees Glomerular filtration Rate zoo dua hauv kev siv Cistanche
Mar 13, 2022
Hu rau: Audrey Hu Whatsapp / hp: 0086 13880143964 Email:audrey.hu@wecistanche.com
Shinichi Nishi 1, Shunsuke Goto1, Makiko Mieno2, Takashi Yagisawa 3 thiab Kenji Yuzawa 4
Abstract
Lub hom phiaj: Peb tau kawm peb hom kev kwv yees glomerular filtration rate (eGFR) sib npaug thiab soj ntsuam seb hom twg muaj feem cuam tshuam nrog cov neeg mob comorbidities nyob rau hauv lub raum transplantation (LKT) pub.
Txoj kev:Peb piv cov Japanese hloov kho eGFR, Hloov Kho Kev Noj Qab Haus Huv Hauv Lub Raum Kab Mob, thiabNtevLub raumKab mobKab mob sib kis sib luag (Jm-eGFR, Jm-MDRD, thiab Jm-CKD-EPI, ntsig txog) rau cov neeg Nyij Pooj LKT pub rau lawv txoj kev sib raug zoo nrog kev rog, ntshav siab, ntshav qab zib, kab mob plawv, thiab mob stroke.
Cov txiaj ntsig:Ntawm 8,176 tus neeg koom nrog Nyiv LKT pub dawb, eGFR suav nrog Jm-CKD-EPI (eGFR / JmCKD-EPI) tau pom qhov sib txawv tseem ceeb hauv 4 ntawm 5 comorbidities ntawm pawg comorbidity-positive thiab comorbidity-negative pawg, whereas eGFR suav nrog Jm- MDRD (eGFR/Jm-MDRD) thiab JmeGFR (eGFR/Jm-eGFR) kuaj pom tsuas yog 3 thiab 1 comorbidities, feem. Lub cheeb tsam nyob rau hauv lub receiver kev khiav hauj lwm tus yam ntxwv nkhaus ntawm Jm-CKD-EPI yog loj dua cov Jm-eGFR thiab Jm-MDRD rau tag nrho tsib comorbidities.
Xaus:Peb pom tias eGFR/Jm-CKD-EPI muaj kev sib raug zoo nrog kev sib raug zoo dua li eGFR/JmeGFR thiab eGFR/Jm-MDRD hauv Nyiv LKT pub dawb. Peb pom zoo kom siv eGFR/Jm-CKD-EPI rau qhov kev ntsuam xyuas thawj zaug ntawm lub raum ua haujlwm hauv LKT cov neeg sib tw pub dawb thaum ntsuas qhov muaj feem cuam tshuam.
Ntsiab lus:ntshav siab, ntshav qab zibmellitus, laus, glomerular pom tus nqi
Cistanche yog qhov zoo rau lub raum ua haujlwm
Taw qhia
Qhov sib txawv kwv yees glomerular filtration rate (eGFR) sib npaug yog siv hauv kev sib kis. Tus eGFR suav nrogNtevLub raumKab mobEpidemiology Collaboration (eGFR/CKD- EPI) equation has been reported to be superior to that calculated using the Modification of Diet in Renal Disease (eGFR/MDRD) equation for predicting the GFR and its relationship with cardiovascular events or mortality (1-4) in studies conducted in a large community-dwelling population (>1, 000). Raws li qhov txwv tsis pub muaj cadaveric pub dawb, kwv yees li 80-90 feem pua ntawm tag nrho cov raum hloov pauv tau nyobraumkev hloov pauv(LKTs) hauv Nyiv (5, 6). Txij li xyoo 2007, qhov feem ntawm cov neeg mob 60-69 thiab 70-79 xyoo tau nce 2- mus rau 3-fold (6). Rau cov txheej txheem nthuav dav LKT cov neeg pub dawb, suav nrog cov neeg laus, tus nqi ntawm cov kab mob sib kis, xws li kub siab, ntshav qab zib, kab mob plawv (CVD), thiab mob stroke, yog nce (7).
Daim ntawv tshaj tawm Amsterdam Forum tau pom zoo siv GFR ntsuas thaum lub sijhawm kuaj xyuas pub dawb (8); Txawm li cas los xij, eGFR / CKD-EPI thiab eGFR / MDRD kuj tau siv rau kev ntsuam xyuas thawj zaug hauv chaw kho mob. KDIGO Cov Lus Qhia Txog Kev Kho Mob ntawm Kev Ntsuam Xyuas thiab Kev Saib Xyuas Kev Noj Qab Haus Huv Hauv Tsev Pabcuam tau tshaj tawm txog kev siv eGFR/CKD-EPI rau qhov kev ntsuam xyuas thawj zaug vim tias nws kwv yees li qhov ntsuas GFR (9). Tsis tas li ntawd, lwm qhov kev kwv yees creatinine-based GFR tau suav tias yog qhov ua tau yog tias qhov tseeb ntawm eGFR tau muab piv rau qhov ntsuas GFR. Qhov tseeb ntawm eGFR yog qhov tseem ceeb, tab sis kev sib raug zoo ntawm eGFR thiab comorbidities yuav tsum tau hais txog.
Hauv Nyij Pooj, eGFR tau suav nrog Japanese hloov eGFR kab zauv (eGFR/Jm-eGFR) (10) los ntsuas lub raum ua haujlwm hauv chaw kho mob. Qhov tseeb ntawm eGFR / Jm-eGFR tau zoo dua nyob rau hauv thaj tsam ntawm kev ntsuas GFR los ntawm inulin clearance (CIn), 0-29 mL/min/1.73 m2, tab sis tsis zoo dua nyob rau hauv ntau ntawm CIn, {{7} } mL/min/1.73 m2 tshaj thaum siv Japanese hloov kho ntawm CKD-EPI (eGFR/ Jm-CKD-EPI) (11). Qhov tseeb ntawm eGFR suav nrog kev hloov kho Japanese ntawm MDRD (eGFR / JmMDRD) tau nce siab dua rau kev ntsuas GFR siv CIn ntawm<60 ml/min/1.73="" m2,="" whereas="" the="" egfr/jmmdrd="" underestimated="" the="" gfr="" using="" a="" cin="" of="" 60="" ml/="" min/1.73="" m2="">
Rau peb txoj kev paub, tsis muaj ib qho kev tshawb fawb tau muab piv rau qhov sib txawv eGFR sib npaug ntawm lawv txoj kev sib raug zoo nrog kev sib txawv hauv cov neeg pub dawb LKT loj. Qhov kev tshawb fawb tam sim no, yog li ntawd, txiav txim siab qhov twg ntawm peb qhov sib npaug eGFR - Jm-eGFR, Jm-MDRD, thiab Jm-NtevLub raumKab mob-EPI (10) - muaj lub koom haum zoo tshaj plaws nrog kev sib koom ua ke ntawm Nyiv LKT pub dawb.
(Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Nyiv, ２Center for Information, Jichi Medical University, Nyiv, ３Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Nyiv , thiab ４National Hospital Organization Mito Medical Center, Nyiv Tau Txais: Lub Kaum Ob Hlis 14, 2020; Txais: Lub Ib Hlis 25, 2021; Kev Tshaj Tawm Ua Ntej los ntawm J-STAGE: Lub Peb Hlis 15, 2021 Cov Lus Teb rau Dr. Shinichi Nishi, {{11 }}-u.ac.jp)
Daim duab 1. Flow chart of cohort selection. JST: Japanese Society of Transplantation, Pts: cov neeg mob, GFR: glomerular filtration, S-Cr: ntshav creatinine, BMI: lub cev qhov hnyav, SBP: systolic ntshav siab, DBP: diastolic ntshav siab
Cov ntaub ntawv thiab cov txheej txheem
Txoj kev tshawb no tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Japanese Society of Transplantation (JST). Peb tau ua txoj kev tshawb fawb hla ntu uas siv cov ntaub ntawv sau npe muab los ntawm JST ntawm 13,330 tus neeg pub LKT sib law liag uas tau txais LKT los ntawm 2009 txog 2017. Cov ntaub ntawv pom zoo hais txog kev sau npe thiab kev tshawb fawb tau txais los ntawm cov neeg pub dawb sau npe. Cov ntaub ntawv Pretransplant, xws li hnub nyoog, poj niam txiv neej, lub cev qhov hnyav (BMI), ntshav siab (BP), ntshav creatinine (SCr), thiab cov ntaub ntawv ntawm tsib qhov kev kho mob preclinical (obesity, kub siab, ntshav qab zib, CVDs, thiab mob stroke), tau sau. Qhov kev kuaj mob ntawm comorbidities tau ua los ntawm cov kws kho mob ua tus saib xyuas raws li cov neeg mob cov ntaub ntawv kho mob lossis cov ntawv sau tshuaj.
The JST guidelines (in Japanese) for LKT donors state that the upper age limit is 80 years, but this limit is based on physical age. The JST defines the approved conditions of LKT donors with comorbidities as follows: 1) The upper limit of HbA1c is 6.2% in diabetic cases without medications and 6.5% in diabetic cases with hypoglycemic agents or insulin. Diabetic cases with retinopathy and/or microalbuminuria are not approved as LKT donors. 2) The ideal BMI is 30 kg/m2, and at least a BMIs of 32 kg/m2 is necessary. 3) Donor candidates with a history of CVD and stroke must be able to tolerate general anesthesia. CVD includes coronary artery disease and heart failure. Stroke includes cerebral infarction and cerebral hemorrhaging. 4) Hypertension is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) >140 lossis 90 mmHg. Cov neeg mob nrog SBP/DBP<140 0="" mmhg="" with="" or="" without="" antihypertensive="" agents="" are="" approved="" as="" lkt="">
Hauv txoj kev tshawb no, peb tau soj ntsuam LKT cov neeg pub dawb nrog kev tswj hwm kev sib raug zoo hauv JST cov lus qhia thiab tsis suav nrog qee qhov xwm txheej (<1% of="" 13,330)="" with="" extremely="" deviant="" data.="" specifically,="" we="" excluded="" uncontrolled="" hypertensive="" patients="" with="" an="" sbp="" 140="" mmhg="" or="" dbp="" 90="" mmhg,="" subjects="">90 years old, men with an SCr of >1.3 mg/dL and women with an SCr of >1.1 mg/dL, and subjects with a BMI >35kg / m2. Cov neeg pub dawb nrog cov ntaub ntawv kho mob tsis txaus raug cais tawm (Daim duab 1). Thaum kawg, 8,176 tus neeg koom tau tso npe rau hauv txoj kev tshawb no.
Cov teeb meem nrog GFR ntsuas raws li creatinine clearance (CCR) thiab CIn 70 mL/min/1.73 m2 tau pom zoo ua LKT pub dawb. Cov neeg pub dawb nrog qhov ntsuas GFR 70-80 thiab 80 mL/min/1.73 m2 tau suav tias yog cov qauv nthuav dav thiab cov qauv pub dawb, raws li JST cov lus qhia. Txawm li cas los xij, cov ntaub ntawv GFR ntsuas tsis suav nrog hauv JST sau npe.Cov qauv rau peb qhov sib npaug eGFR yog raws li hauv qab no: Jm-eGFR{{10}} × SCr-1.094 × hnub nyoog{ {13}}.287 × 0.739 (rau cov poj niam) (12), Jm-MDRD=0.808 × 175 × SCr-1.154 × hnub nyoog{24}}.203 × 0.742 (rau poj niam) (12), Jm-CKD-EPI=0.813 × 141 × min (SCr/κ, 1) ×max (SCr/κ, 1)-1.209 × 0.993age × 1.018 (rau cov poj niam) (12),
qhov twg κ yog {{0}}.9 rau txiv neej thiab 0.7 rau poj niam, yog -0.411 rau txiv neej thiab -0.329 rau poj niam, min yog qhov tsawg kawg nkaus ntawm SCr/ κ los yog 1, thiab max yog qhov siab tshaj plaws (SCr/κ, 1) lossis 1.
Table 1. Cov ntaub ntawv hauv paus ntawm cov neeg pub dawb ua ntej Kev hloov pauv raum nyob (n=8,176).
Values are presented as mean±standard deviation or n (%). Elderly: age >70 years, BMI: body mass index, obesity: BMI >30 kg/m2, eGFR: kwv yees glomerular filtration rate, Jm: Japanese modified, MDRD: Modification of Diet in Renal Disease, CKD-EPI:Mob raum mobEpidemiology Collaboration, SBP: systolic ntshav siab, DBP: diastolic ntshav siab, HT: kub siab, DM: ntshav qab zib, CVD: kab mob plawv.
Kev txheeb cais
Cov kev hloov pauv tsis tu ncua tau nthuav tawm raws li qhov nruab nrab ± tus qauv sib txawv. Categorical variables raug nthuav tawm raws li feem pua. Kev txheeb xyuas txheeb cais tau ua tiav siv SPSS version 18.0 software program (IBM, Armonk, USA). Cov kev hloov pauv tsis tu ncua tau muab piv nrog Cov Tub Ntxhais Kawm T-test. Cov kev hloov pauv tsis txuas ntxiv tau txheeb xyuas siv qhov ntsuas chi-square. Kev sib raug zoo raug soj ntsuam siv Pearson qhov kev txheeb xyuas kev sib raug zoo. Tus neeg txais kev ua haujlwm yam ntxwv (ROC) nkhaus tau kos ntawm eGFR qhov tseem ceeb suav nrog peb qhov sib npaug thiab kev sib luag. Rau kev tsom xam, peb siv Jonckheere-Terpstra tsom xam. ob sab p tus nqi<0.05 were="" considered="" statistically="">
Cov txiaj ntsig
Baseline data are presented in Table 1. We compared the mean eGFR for the three types of equations between the elderly (age >70 xyoo) thiab cov pab pawg uas tsis yog neeg laus thiab nruab nrab ntawm cov pab pawg comorbidity-positive thiab comorbidity-negative pawg (Table 2) thiab pom qhov sib txawv tseem ceeb ntawm cov neeg laus thiab cov tsis- laus laus rau tag nrho peb eGFRs. Thaum sib piv txhais tau tias eGFR / Jm-eGFR, rog rog, kub siab, thiab CVD pom qhov sib txawv tseem ceeb. Thaum muab piv rau qhov nruab nrab eGFR / Jm-MDRD, qhov sib txawv tseem ceeb tau pom tsuas yog hauv kev rog xwb. Thaum sib piv qhov nruab nrab eGFR / Jm-CKD-EPI, rog rog, ntshav siab, ntshav qab zib, thiab CVD pom qhov sib txawv tseem ceeb. Tsis muaj qhov sib txawv tseem ceeb hauv qhov nruab nrab eGFR tau pom rau mob stroke siv txhua qhov sib npaug.
The positive rates of the 5 comorbidities in the elderly (age >70 years old) and non-elderly groups are shown in Fig. 2. The positive rates for hypertension, 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 xyoo) thiab comorbidity tus nqi nthuav tawm qhov sib txawv tseem ceeb (p<>
cistanche tuaj yeem txhim kho kev sib deev
Kev sib raug zoo ntawm lub hnub nyoog thiab eGFR suav nrog 3 qhov sib npaug yog qhov tseem ceeb (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="">
Fig. 3a shows the ROC analysis between the eGFRs calculated using the three equations and the five comorbidities of obesity, hypertension, diabetes, 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 in relation to 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 xyoo), (n=798). Lub ROC nkhaus ntawm eGFR / Jm-CKD-EPI nthuav tawm sab laug ua haujlwm piv nrog cov eGFR / Jm-eGFR thiab eGFR / JmMDRD nyob rau hauv kev sib raug zoo rau comorbidities.Cov comorbidity tus nqi, uas yog<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="">
Rooj 2. Kev sib piv ntawm eGFR suav nrog Kev Siv Peb Qhov Kev Sib Tw ntawm Cov Neeg Laus thiab Cov Neeg Tsis Muaj Cov Neeg Laus thiab nruab nrab ntawm pawg Comorbidity-positive thiab Comorbidity-negative pawg.
eGFR:kwv yees glomerular filtration rate, Jm: Nyiv hloov kho, MDRD: Hloov Kho Kev Noj Qab Haus Huv Hauv Lub Raum Kab Mob, CKD-EPI:Mob raum mobEpidemiology Collaboration, elderly: age >70 years, obesity: body mass index >30 kg/m2, HT: kub siab, DM: ntshav qab zib, CVD: kab mob plawv.
Daim duab 2. Comorbidity rates in the non-elderly and elderly groups. Excluding obesity (body mass index >30 kg/m2 ), the rates of comorbidities in the elderly group (age >70 xyoo) tau 2-3 npaug ntau dua li cov neeg tsis yog neeg laus (hnub nyoog qis dua lossis sib npaug li 70 xyoo). HT: kub siab, DM: ntshav qab zib, CVD: kab mob plawv.
Kev sib tham
Ntawm peb eGFRs, eGFR/Jm-CKD-EPI sib cuam tshuam nrog cov comorbidities. eGFR/Jm CKD-EPI, eGFR/Jm-eGFR, thiab eGFR/Jm-MDRD tau kuaj pom qhov sib txawv tseem ceeb hauv plaub, peb, thiab ib qho ntawm tsib qhov sib txawv, raws li (Table 2). Hauv kev txheeb xyuas ROC (Daim duab 3), eGFR/Jm-CKD-EPI yog qhov zoo tshaj plaws ntawm kev sib raug zoo ntawm comorbidities. Ib qho kev tsom xam (Table 3) qhia qhov zoo tshaj ntawm eGFR/Jm-CKD-EPI hauv qhov poob ntawm eGFR (Fig. 3).
Thaum tus neeg thov kev pab cuam ntsuam xyuas ua ntej hloov pauv, eGFR/CKD-EPI tuaj yeem siv rau qhov kev ntsuam xyuas thawj zaug. Kev saib xyuas ntxiv yuav tsum tau muab rau cov neeg mob uas tau txais nyiaj pub dawb los ntawm cov neeg pub dawb uas tsis tshua muaj eGFR/CKD-EPI (<70 ml/min/1.73="" m2="" ),="" which="" is="" most="" strongly="" associated="" with="" the="" five="" comorbidities="" and="" 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)="">
Daim duab 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 xyoo). n{1},378. AUROC: cheeb tsam nyob rau hauv lub receiver kev khiav hauj lwm yam ntxwv nkhaus, ROC: receiver kev khiav hauj lwm yam ntxwv, AUC: cheeb tsam nyob rau hauv lub nkhaus, BMI: lub cev qhov hnyav Performance index, eGFR: kwv yees glomerular filtration rate, HT: kub siab, DM: ntshav qab zib, CVD: kab mob plawv, Jm : Japanese hloov kho, MDRD: Hloov Kho Kev Noj Qab Haus Huv Hauv Lub Raum Kab Mob, CKD-EPI:NtevLub raumKab mobKev sib kis kab mob sib kis. Txoj kab liab yog Jm-CKD-EPI, kab xiav yog Jm-eGFR, thiab kab ntsuab yog Jm-MDRD.
Hauv cov kev tshawb fawb hla ntu, qis dua eGFR / CKD-EPI tau pom tias muaj kev sib koom ua ke zoo dua nrog kev sib kis ntau dua li eGFR / MDRD hauv Caucasian cov neeg nyob hauv zej zog. Tarantini et al. (4) qhia tias nyob rau hauv cov neeg mob nrog CVD, qhov feem ntau ntawm CVD yog siab dua thaum ntsuas eGFR / CKD-EPI dua li thaum ntsuas eGFR / MDRD hauv pawg eGFR qis. Juutilaen et al. (13) soj ntsuam cov nqi ntawm comorbidities, xws li kub siab, rog rog, ntshav qab zib, thiab CVD, nyob rau hauv cov neeg mob nrog CKD thiab pom muaj ntau dua cov neeg mob uas muaj comorbidities thaum qhov kev ntsuam xyuas tau siv eGFR / CKD-EPI tshaj li thaum nws tau ua. siv eGFR/MDRD.
Peb tau lees paub qhov tseeb ntawm eGFR/Jm-CKD-EPI hauv cov ntaub ntawv. Rule et al. (14) tau tshaj tawm tias qhov sib npaug CKD-EPI yog qhov tseeb dua li MDRD hauv cov neeg muaj kev pheej hmoo tsawg, suav nrog kev pub dawb ua ntej thiab tom qab pub raum pub dawb. Murata et al. (15) tau tshaj tawm tias creatinine-raws li eGFR/CKD-EPI tau pom tias muaj kev tsis ncaj ncees tsawg dua li eGFR/MDRD hauv cov neeg pub LKT muaj peev xwm (−8 feem pua vs. −18 feem pua). Burballa thiab al. (16) thiab Gaillard et al. (17) piv cov txiaj ntsig ntawm creatinine-based eGFR / CKD-EPI, eGFR / MDRD, thiab mGFR nrog cov isotopes hauv cov neeg pub dawb ua ntej LKT thiab xaus lus tias eGFR / CKD-EPI sib raug zoo nrog mGFR dua li eGFR / MDRD. Horio et al. (18) piv qhov tseeb ntawm eGFR/Jm-CKD-EPI thiab eGFR/Jm-MDRD nrog cov ntsuas inulin GFR hauv cov neeg kuaj mob hauv Nyij Pooj. Hauv kev npau taws ntawm kev ntsuas inulin GFR 60 mL / min / 1.73 m2, qhov kev tsis ncaj ncees (mGFR-eGFR) yog 7.3 ± 20.6 mL / min / 1.73 m2 hauv eGFR / Jm-CKD-EPI thiab 7.8 ± 22.2 mL / min / 1.73 m2 hauv eGFR/Jm-MDRD, ntsig txog (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="">
Cistanche tuaj yeem txhim kho kev sib deev tsis zoo
We explored why the eGFR/Jm-CKD-EPI was superior regarding its relationship with the five evaluated comorbidities, 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). A ROC analysis revealed that the eGFR/JmCKD-EPI was better associated with older age (>70 xyoo) piv rau eGFR/Jm-eGFR thiab eGFR/JmMDRD (Fig. 3a). Yog li ntawd, peb ntseeg hais tias qhov sib npaug tus yam ntxwv ntawm lub hnub nyoog rhiab heev yog lub luag hauj lwm rau lub superiority ntawm eGFR/Jm-CKD-EPI.
Ji et al. kawm txog kev sib raug zoo ntawm eGFR thiab preclinical lub hom phiaj kev puas tsuaj rau lub cev hauv kev kub siab siv ROC kev tshuaj ntsuam thiab tau tshaj tawm tias eGFR / Suav CKD-EPI qhov sib npaug tau zoo dua cuam tshuam nrog cov teeb meem hnyav dua li eGFR / Suav thiab Asian- hloov kho MDRD sib npaug (20). eGFR / CKD-EPI tau cuam tshuam zoo dua li ntawm eGFR / MDRD nrog cov ntaub ntawv xov xwm thickness, pob taws-brachial Performance index, sab laug ventricular mass Performance index, zis albumin-to-creatinine ratio, thiab aortic pulse wavevelocity. Hauv peb txoj kev tshawb fawb, txo qis cov neeg laus, eGFR/CKD-EPI tau zoo dua nrog kev sib koom ua ke hauv LKT cov neeg pub dawb dua li eGFR/ Jm-eGFR thiab eGFR/Jm-MDRD (Fig. 3b). Yog li, eGFR / CKD-EPI tej zaum yuav muaj kev cuam tshuam rau kev mob ntshav siab lossis atherosclerotic teeb meem, tsis suav nrog cov hnub nyoog laus dua. eGFR/Jm-CKD-EPI raug pom zoo siv rau hauv kev soj ntsuam kev pheej hmoo, tsis yog rau lub raum kev puas tsuaj nkaus xwb tab sis kuj muaj kev puas tsuaj rau lub cev, uas qhia txog cov teeb meem hnyav hauv LKT cov neeg pub dawb.
eGFR/CKD-EPI tau tshaj tawm tias nws zoo dua rau eGFR/MDRD hauv kev kwv yees ntawm CVD cov xwm txheej lossis kev tuag hauv cov neeg Caucasian (1-3). Hauv Suav cov neeg koom, eGFR / CKD-EPI yog qhov kev kwv yees zoo dua ntawm kev mob stroke rov qab thiab tuag dua li eGFR / MDRD (21). Raws li txoj cai, Matsushita et al. (22) tau tshaj tawm tias eGFR/JmCKD-EPI yog qhov kev kwv yees zoo dua ntawm kev pheej hmoo ntawm txhua qhov ua rau thiab cov hlab plawv tuag ntau dua li eGFR/Jm-MDRD hauv thaj tsam ntawm eGFR 60 mL/min/1.73 m2 nyob rau hauv Japanese cov neeg koom. Terawaki et al. (3) siv ROC tsom xam los sib piv qhov kwv yees qhov tseem ceeb rau CVD thiab mob stroke ntawm eGFR / Jm-CKD-EPI thiab eGFR / Jm-MDRD thiab tshaj tawm tias AUROCs rau CVD cov xwm txheej hauv eGFR / Jm-CKD-EPI thiab eGFR /Jm-eGFR yog 0.596 thiab 0.562, feem. eGFR / CKD-EPI tau sib raug zoo nrog CVD tshwm sim hauv 241,159 tus neeg Nyij Pooj (lub hnub nyoog nruab nrab, 64 xyoo) uas tau kuaj xyuas kev noj qab haus huv. Ohsawa et al. (23) tau tshaj tawm qhov kev kwv yees zoo dua rau txhua qhov kev tuag, myocardial infarction, thiab mob stroke nrog eGFR / Jm-CKD-EPI dua li nrog eGFR / Jm-MDRD hauv pawg kuaj xyuas kev noj qab haus huv. Yog li, eGFR / CKD-EPI yog qhov zoo tshaj rau kev kwv yees CVD cov xwm txheej thiab kev tuag hauv cov neeg nyob hauv zej zog. Peb yuav tsum ua tib zoo saib xyuas cov neeg pub dawb uas tsis tshua muaj eGFR/CKD-EPI tom qab hloov pauv.
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 case).
Table 3.Tus nqi Comorbidity hauv peb pawg eGFR<70, 70-80,="" ≥80="" ml/min/1.73m2="" calculated="" by="" each="" egfr="">
p qhov tseem ceeb tau soj ntsuam los ntawm Jonckheere-Terpstra tsom xam. eGFR/Jm-eGFR: kwv yees glomerular filtration rate, JM: Nyiv hloov kho, MDRD: Hloov Kho Kev Noj Qab Haus Huv Hauv Lub Raum Kab Mob, CKD-EPI:NtevLub raum Kab mobEpidemiology Collaboration, Elderly: age >70 years, Obesity: body mass index >30 kg/m2, HT: kub siab, DM: ntshav qab zib, CVD, kab mob plawv.
Xaus
eGFR / Jm-CKD-EPI tau zoo dua nrog kev sib xyaw ua ke, suav nrog kev rog, ntshav siab, ntshav qab zib, CVD, thiab mob stroke, dua li eGFR / Jm-eGFR thiab eGFR / JmMDRD hauv cov neeg muaj kev pheej hmoo tsawg, xws li Japanese LKT pub dawb. Rau qhov kev ntsuam xyuas thawj zaug ntawm lub raum kev ua haujlwm ntawm LKT cov neeg sib tw pub dawb, eGFR / Jm-CKD-EPI raug pom zoo, tshwj xeeb tshaj yog rau cov qauv nthuav dav pub dawb nrog comorbidities.
Cov kws sau ntawv hais tias lawv tsis muaj qhov tsis sib haum xeeb ntawm kev txaus siab (COI)
Kev them nyiaj yug
Txoj kev tshawb fawb no tau txais kev txhawb nqa los ntawm ib feem los ntawm kev pab nyiaj pub dawb rau Kev Tshawb Fawb TxogAdvanced Chronic Kidney Disease(REACH-J), Kev Tshawb Fawb Txog Kev Tshawb Fawb Txog Kab Mob Raum los ntawm Nyiv Lub Koom Haum rau Kev Tshawb Fawb Txog Kev Kho Mob thiab Kev Txhim Kho (AMED), thiab ib feem los ntawm kev pab nyiaj pab rau kev tshawb xyuas cov pov thawj tshiab kom nkag siab txog kev nyab xeeb ntawm kev hloov lub raum los ntawm cov neeg pub nyiaj marginal. zoo li Kev Txhawb Kev Tiv Thaiv Kab Mob Raum los ntawm Nyiv Lub Chaw Haujlwm Saib Xyuas Kev Tshawb Fawb thiab Kev Txhim Kho (AMED).
Cistanche tuaj yeem tonify raum
Cov ntaub ntawv
1. Gelsomino S, Bonacchi M, Lucà F, et al. Kev sib piv ntawm peb qhov sib npaug sib txawv rau kev kwv yees ntawm glomerular pom tus nqi hauv kev kwv yees kev tuag tom qab coronary artery bypass. BMC Nephrol 20: 371, 2019.
2. Shara NM, Wang H, Mete M, et al. Kwv yees GFR thiab xwm txheej kab mob plawv hauv Asmeskas Khab: Txoj Kev Kawm Lub Siab Muaj Zog. Am J Raum Dis 60: 795-803, 2012.
3. Terawaki H, Nakayama M, Asahi K, et al. Kev sib piv ntawm kev kwv yees tus nqi rau thawj lub plawv mob plawv ntawm Japanese GFR equation thiab coefficient-modified CKD-EPI equation. Clin Exp Nephrol 19: 387-394, 2015.
4. Tarantini L, Barbati G, Cioffi G, et al. Kev soj ntsuam cuam tshuam ntawm CKD epidemiology kev sib koom ua ke (CKD-EPI) sib npaug piv nrog kev hloov pauv ntawm kev noj zaub mov hauv lub raum kab mob (MDRD) kev kawm sib npaug rau kev kwv yees ntawm lub raum tsis ua haujlwm hauv cov neeg mob plawv. Intern Emerg Med 10: 955-963, 2015.
5. Yagisawa T, Mieno MN, Yoshimura N, Yuzawa K, Takahara S. Cov xwm txheej tam sim no ntawm kev hloov lub raum hauv Nyij Pooj xyoo 2015: cov ntaub ntawv ntawm Pawg Neeg Saib Xyuas Kev Hloov Kho Raum, Nyiv Lub Koom Haum rau Kev Kho Mob Raum Hloov Pauv thiab Nyiv Lub Koom Haum rau Kev Hloov Pauv. Ren Hloov Ther 2: 68, 2016.
6. Yagisawa T, Mieno MN, Ichimaru N, et al. Kev hloov pauv raum hauv Nyij Pooj xyoo 2018: cov ntaub ntawv los ntawm lub raum hloov pauv npe. Ren Hloov Ther 5: 3, 2019.
7. Kinoshita Y, Yagisawa T, Sugihara T, et al. Cov txiaj ntsig kho mob hauv cov neeg pub dawb thiab cov neeg tau txais kev hloov pauv raum cuam tshuam nrog kev kho mob nyuaj rau cov neeg pub dawb - kev tshawb fawb rov qab. Transpl Int 33: 1417-1423, 2020.
8. Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Lub Koom Haum Hloov Pauv. Cov lus pom zoo ntawm Amsterdam Lub Rooj Sab Laj ntawm Kev Saib Xyuas Kev Noj Qab Haus Huv Hauv Tsev. Kev hloov pauv 78: 491-492, 2004.
9. Lentine KL, Kasiske BL, Levey AS, et al. KDIGO cov txheej txheem kev kho mob rau kev soj ntsuam thiab saib xyuas cov neeg mob raum nyob. Hloov pauv 101 (Suppl): S1-S109, 2017.
10. Horio M, Imai E, Yasuda Y, Watanabe T, Matsuo S. Kev ua tau zoo ntawm GFR equations hauv cov neeg koom nrog Japanese. Clin Exp Nephrol 17: 352-358, 2013.
11. Imai E, Horio M, Nitta K, et al. Kev kwv yees ntawm glomerular filtration rate los ntawm MDRD txoj kev kawm sib npaug hloov kho rau cov neeg Nyij Pooj uas muaj kab mob raum ntev. Clin Exp Nephrol 11: 41-50, 2007.
12. Matsuo S, Imai E, Horio M, et al. Hloov kho qhov sib npaug rau kwv yees GFR los ntawm cov ntshav creatinine hauv Nyiv. Am J Raum Dis 53: 982- 992, 2009.
13. Juutilainen A, Kastarinen H, Antikainen R, et al. Kev sib piv ntawm MDRD Txoj Kev Kawm thiab CKD-EPI Txoj Kev Kawm sib npaug hauv kev soj ntsuam cov qauv ntawm kev kwv yees lub raum ua haujlwm ntawm cov pejxeem: kev tshawb pom los ntawm National FINRISK Study. Nephrol Dial Transplant 27: 3210-3217, 2012.
14. Txoj Cai AD, Glassock RJ. GFR kwv yees qhov sib npaug: tau los ze rau qhov tseeb? Clin J Am Soc Nephrol 8: 1414-1420, 2018.
15. Murata K, Baumann NA, Saenger AK, et al. Cov txheeb ze kev ua tau zoo ntawm MDRD thiab CKD- EPI sib npaug rau kev kwv yees glomerular filtration tus nqi ntawm cov neeg mob uas muaj ntau yam kev nthuav qhia kho mob. Clin J Am Soc Nephrol 6: 1963-1972, 2011.
16. Burballa C, Crespo M, Redondo-Pachón D, et al. MDRD lossis CKDEPI rau glomerular filtration tus nqi kwv yees hauv cov neeg mob raum nyob. Nefrologia 38: 207-212, 2018.
17. Gaillard F, Courbebaisse M, Kamar N, et al. Kev cuam tshuam ntawm kev kwv yees piv rau kev ntsuas ncaj qha ntawm kev pub dawb ua ntej glomerular pom tus nqi ntawm qhov tsim nyog ntawm cov neeg muaj peev xwm nyob hauv lub raum. Lub raum Int 95: 896-904, 2019.
18. Horio M, Imai E, Yasuda Y, Watanabe T, Matsuo S. Kev hloov kho ntawm CKD kev sib kis kab mob sib koom ua ke (CKD-EPI) kev sib npaug rau cov neeg Nyij Pooj: qhov tseeb thiab siv rau kev kwv yees pej xeem. Am J Raum Dis 56: 32-38, 2010.
19. Horio M, Yasuda Y, Kanamori J, et al. Kev ua tau zoo ntawm Japanese GFR sib npaug hauv cov peev xwm raum pub. Clin Exp Nephrol 16: 415-420, 2012.
20. Ji H, Zhang H, Xiong J, et al. Cov eGFRs los ntawm Asian-hloov CKD-EPI thiab Suav-hloov CKD-EPI sib npaug tau cuam tshuam zoo dua nrog kev mob siab rau lub cev puas tsuaj hauv zej zog cov neeg laus hauv Suav: Northern Shanghai Study. Clin Interv Hnub nyoog 12: 1297-1308, 2017.
21. Wang X, Luo Y, Wang Y, et al. Kev sib piv ntawm cov koom haum ntawm cov txiaj ntsig tom qab mob stroke nrog kwv yees GFR siv Suav kev hloov kho ntawm MDRD txoj kev tshawb fawb thiab CKD-EPI creatinine sib npaug: tau los ntawm Tuam Tshoj National Stroke Registry. Am J Raum Dis 63: 59-67, 2014.
22. Matsushita K, Mahmoodi BK, Woodward M, et al. Kev sib piv ntawm kev pheej hmoo kwv yees siv CKD-EPI kab zauv thiab MDRD txoj kev sib npaug rau kwv yees glomerular filtration rate. JAMA 307: 1941- 1951, 2012.
23. Ohsawa M, Tanno K, Itai K, et al. Kev sib piv ntawm kev kwv yees txog yav tom ntej ntawm cov kab mob plawv ntawm cov kab mob raum ntev (CKD) theem raws li CKD kab mob sib kis sib koom ua ke thiab ua raws li kev hloov pauv ntawm kev noj zaub mov hauv lub raum kab sib npaug hauv cov pej xeem Nyij Pooj --Iwate KENCO Txoj Kev Kawm. Circ J 77: 1315-1325, 2013.