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期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.8523

摘要内容如下：

重要性

最近的指南呼吁对活体肾脏捐赠后的健康结果提供更好的证据。

目的

确定捐献肾脏的血压正常成人与基线健康状况相似的非捐献者相比患高血压的风险。还比较了他们的估计肾小球滤过率（EGFR）下降率和蛋白尿风险。

设计、设置和参与者

一项前瞻性队列研究，纳入924名标准活体肾脏捐献者和396名非捐献者。从2004年到2014年，17个移植中心（12个在加拿大，5个在澳大利亚）进行了招募。随访至2021年11月。捐献者和非捐献者的年度随访评估时间表相同。使用倾向评分的治疗加权的逆概率来平衡供者和非供者的基线特征。

曝光

活体捐肾。

主要成果和措施

高血压（收缩压[SBP]≥140 mm Hg，舒张压[DBP]≥90 mm Hg，或服用抗高血压药物）、EGFR的年度变化（非献血者在献血后12个月/模拟献血日开始）和蛋白尿（白蛋白与肌酐的比值≥3 mg/mmol[≥30 mg/G]）。

结果

在924名捐献者中，66%为女性；他们的平均年龄为47岁，平均EGFR为100 mL/min/1.73 m2。捐献者比非捐献者更可能有肾衰竭家族史（分别为464/922[50%]和89/394[23%]）。统计加权后，非捐献者的样本增加到928个，两组的基线特征相似。在中位数为7.3年的随访期间（IQR，6.0-9.0），在加权分析中，924名献血者中有161名（17%）和928名非献血者中有158名（17%）发生高血压（加权风险比，1.11[95%CI，0.75-1.66]）。献血者和非献血者平均血压的纵向变化相似。在肾切除术后供者的EGFR最初下降（平均值为32 mL/min/1.73 m2）后，供者的EGFR每年下降1.4 mL/min/1.73 m2（95%CI，1.2-1.5），低于非供者。然而，在随访中至少有一次EGFR在30至60 mL/min/1.73 m2之间的供者多于非供者（438/924[47%]vs 49/928[5%]）。905名献血者中有132名（15%）和904名非献血者中有95名（11%）发生蛋白尿（加权风险比，1.46[95%CI，0.97-2.21]）；白蛋白与肌酐比值的加权组间差异为1.02（95%CI，0.88-1.19）。

结论和相关性

在这项对活体肾脏捐献者和非捐献者进行相同随访计划的队列研究中，高血压和蛋白尿的风险没有显著差异。肾切除术后EGFR初始下降后，供者的EGFR平均下降率比非供者慢，但在随访中至少有一次EGFR更可能在30至60 mL/min/1.73 m2之间。

试用注册

ClinicalTrials.gov标识符：NCT00936078。

英文原文如下：

Abstracts

Importance  Recent guidelines call for better evidence on health outcomes after living kidney donation.

Objective  To determine the risk of hypertension in normotensive adults who donated a kidney compared with nondonors of similar baseline health. Their rates of estimated glomerular filtration rate (eGFR) decline and risk of albuminuria were also compared.

Design, Setting, and Participants  Prospective cohort study of 924 standard-criteria living kidney donors enrolled before surgery and a concurrent sample of 396 nondonors. Recruitment occurred from 2004 to 2014 from 17 transplant centers (12 in Canada and 5 in Australia); follow-up occurred until November 2021. Donors and nondonors had the same annual schedule of follow-up assessments. Inverse probability of treatment weighting on a propensity score was used to balance donors and nondonors on baseline characteristics.

Exposure  Living kidney donation.

Main Outcomes and Measures  Hypertension (systolic blood pressure [SBP] ≥140 mm Hg, diastolic blood pressure [DBP] ≥90 mm Hg, or antihypertensive medication), annualized change in eGFR (starting 12 months after donation/simulated donation date in nondonors), and albuminuria (albumin to creatinine ratio ≥3 mg/mmol [≥30 mg/g]).

Results  Among the 924 donors, 66% were female; they had a mean age of 47 years and a mean eGFR of 100 mL/min/1.73 m2. Donors were more likely than nondonors to have a family history of kidney failure (464/922 [50%] vs 89/394 [23%], respectively). After statistical weighting, the sample of nondonors increased to 928 and baseline characteristics were similar between the 2 groups. During a median follow-up of 7.3 years (IQR, 6.0-9.0), in weighted analysis, hypertension occurred in 161 of 924 donors (17%) and 158 of 928 nondonors (17%) (weighted hazard ratio, 1.11 [95% CI, 0.75-1.66]). The longitudinal change in mean blood pressure was similar in donors and nondonors. After the initial drop in donors' eGFR after nephrectomy (mean, 32 mL/min/1.73 m2), donors had a 1.4-mL/min/1.73 m2 (95% CI, 1.2-1.5) per year lesser decline in eGFR than nondonors. However, more donors than nondonors had an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up (438/924 [47%] vs 49/928 [5%]). Albuminuria occurred in 132 of 905 donors (15%) and 95 of 904 nondonors (11%) (weighted hazard ratio, 1.46 [95% CI, 0.97-2.21]); the weighted between-group difference in the albumin to creatinine ratio was 1.02 (95% CI, 0.88-1.19).

Conclusions and Relevance  In this cohort study of living kidney donors and nondonors with the same follow-up schedule, the risks of hypertension and albuminuria were not significantly different. After the initial drop in eGFR from nephrectomy, donors had a slower mean rate of eGFR decline than nondonors but were more likely to have an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up.

Trial Registration  ClinicalTrials.gov Identifier: NCT00936078.

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