Hloov kho raum mob raum kab mob sib kis kev sib koom ua ke sib npaug rau qhov kwv yees Glomerular filtration Rate tau zoo dua nrog kev sib koom ua ke dua li lwm qhov sib npaug hauv cov neeg mob raum nyob hauv Nyij Pooj Ⅱ

Cov txiaj ntsig

Cov ntaub ntawv hauv paus tau nthuav tawm hauv Table 1. Peb muab piv rau qhov nruab nrabeGFR 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, ntshav siab, thiabCVD tau nthuav tawmqhov 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 nthuav tawm 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 xyoo) thiab cov pab pawg uas tsis yog neeg laus muaj nyob rau hauv daim duab 2. Cov nqi zoo rauntshav siab, 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<0.001).

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Kev sib raug zoo ntawm lub hnub nyoog thiabeGFR xamsiv 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 = 0.083).

Daim duab 3a qhia txog ROC tsom xam ntawm eGFRs suav nrog peb qhov sib npaug thiabtsib comorbidities ntawm rog, ntshav siab, ntshav qab zib, 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 xyoo), (n=798). Lub ROC nkhaus ntawm eGFR / Jm-CKD-EPI tau nthuav tawm sab laug ua haujlwm piv nrog cov ntawm eGFR / Jm-eGFR thiab eGFR / Jm MDRD txog cov comorbidities. Tus nqi comorbidity, 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 m2.

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 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).

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 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 : Nyiv hloov kho, MDRD: Kev Hloov Kho Kev Noj Qab Haus Huv Hauv Lub Raum Kab Mob, CKD-EPI: Kev Sib Koom Tes Hauv Lub raum 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, ntshav qab zib, thiab CVD, nyob rau hauv cov neeg mob nrog CKD thiab pom ib tug ntau dua ntawm 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-based eGFR / CKD-EPI tau pom tias muaj kev tsis ncaj ncees tsawg dua li eGFR / MDRD hauv cov neeg muaj peev xwm LKT (−8% vs. −18%). 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 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 xyoo) piv rau eGFR/Jm-eGFR thiab eGFR/Jm MDRD (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). Consis tsev pheeb suab, Matsushita, et al. (22) tau tshaj tawm tias eGFR/Jm CKD-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 nrog cov neeg pub dawb nrog qis 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).

Xaus

eGFR/Jm-CKD-EPI tau zoo dua txuam nrog comorbidities, suav nrog kev rog, ntshav siab, ntshav qab zib, CVD, thiab mob stroke dua li eGFR/Jm-eGFR thiab eGFR/Jm MDRD 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 txheej txheem nthuav dav pub dawb nrog comorbidities.