Pre-donation assessment of cystatin C to improve prediction of pre- and post-donation GFR in potential living kidney donors.

IF 4.8 2区 医学 Q1 TRANSPLANTATION Nephrology Dialysis Transplantation Pub Date : 2024-10-30 DOI:10.1093/ndt/gfae065
Jessica van der Weijden, Daan Kremer, Lisa B Westenberg, Jan-Stephan F Sanders, Robert A Pol, Ilja M Nolte, Martin H De Borst, Stefan P Berger, Stephan J L Bakker, Marco van Londen
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Abstract

Background: Accurate estimation of glomerular filtration rate (GFR) is crucial in living kidney donation. While most estimated GFR (eGFR) equations are based on plasma creatinine, its levels are strongly influenced by muscle mass. Application of cystatin C (cysC)-based estimates before donation may improve both estimation of current GFR and prediction of post-donation GFR.

Methods: We assessed the performance of Chronic Kidney Disease Epidemiology Collaboration equations based on creatinine (eGFRcreat-2009, eGFRcreat-2021), cysC (eGFRCysC-2012) or both (eGFRcombined-2012, eGFRcombined-2021) for estimating pre- and post-donation (mGFR) GFR in 486 living kidney donors. We subsequently focused on a subgroup of individuals with high/low muscle mass (25% highest/lowest 24-hour urinary creatinine excretion, sex stratified and height indexed).

Results: Pre-donation eGFRcombined-2012 and eGFRcombined-2021 showed the strongest associations with pre- and post-donation mGFR. Pre-donation eGFRcombined-2021 was most accurate for estimating both pre-donation (bias 0.01 ± 11.9 ml/min/1.73 m2) and post-donation mGFR (bias 1.3 ± 8.5 ml/min/1.73 m2). In donors with high/low muscle mass, cysC-based equations (with or without creatinine) performed better compared with equations based on only creatinine.

Conclusions: Combined eGFR equations yielded a better estimate of pre- and post-donation mGFR compared with estimates based on creatinine or cysC only. The added value of cysC seems particularly pronounced in donors with high or low muscle mass.

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捐献前评估胱抑素 C 以改进对潜在活体肾脏捐献者捐献前和捐献后 GFR 的预测。
背景和假设:准确估计肾小球滤过率(GFR)对活体肾脏捐赠至关重要。虽然大多数电子肾小球滤过率方程都基于血浆肌酐,但血浆肌酐水平受肌肉质量的影响很大。在捐献前应用基于胱抑素 C (CysC) 的估计值可改善对当前 GFR 的估计和对捐献后 GFR 的预测:我们评估了基于肌酐(eGFRcreat-2009、eGFRcreat-2021)、胱抑素 C(eGFRCysC-2012)或两者(eGFRcombined-2012、eGFRcombined-2021)的 CKD-EPI 方程在估计 486 名活体肾脏捐献者捐献前和捐献后测量的 GFR 方面的性能。随后,我们重点研究了肌肉质量高/低(24 小时尿肌酐排泄量最高/最低的 25%,性别分层,身高指数化)的个体亚组:结果:捐献前 eGFRcombined 2012 和 eGFRcombined 2021 与捐献前和捐献后 mGFR 的关联性最强。捐献前 eGFR 组合 2021 对捐献前(偏差为 0.01±11.9 mL/min/1.73 m2)和捐献后 mGFR(偏差为 1.3±8.5 mL/min/1.73 m2)的估计最为准确。在肌肉质量高/低的供体中,基于 CysC 的方程(含肌酐或不含肌酐)比仅基于肌酐的方程表现更好:总之,与仅基于肌酐或 CysC 的估计值相比,联合 eGFR 方程能更好地估计捐献前和捐献后的 mGFR。CysC 的附加值在肌肉质量高或低的捐献者中似乎尤为明显。
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来源期刊
Nephrology Dialysis Transplantation
Nephrology Dialysis Transplantation 医学-泌尿学与肾脏学
CiteScore
10.10
自引率
4.90%
发文量
1431
审稿时长
1.7 months
期刊介绍: Nephrology Dialysis Transplantation (ndt) is the leading nephrology journal in Europe and renowned worldwide, devoted to original clinical and laboratory research in nephrology, dialysis and transplantation. ndt is an official journal of the [ERA-EDTA](http://www.era-edta.org/) (European Renal Association-European Dialysis and Transplant Association). Published monthly, the journal provides an essential resource for researchers and clinicians throughout the world. All research articles in this journal have undergone peer review. Print ISSN: 0931-0509.
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