Predictors and Impact of Low GFR After Living Kidney Donation

活体肾脏捐赠后低 GFR 的预测因素和影响

• 批准号: 7637812
• 负责人: Elizabeth Ommen
• 金额: $ 13.75万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7637812
• 关键词: Area; Blood Pressure; Blood Tests; Body mass index; C-reactive protein; Cardiovascular system; Characteristics; Chronic Kidney Failure; Clinical; Clinical Research; Collection; Creatinine; Cross-Sectional Studies; Data; Data Collection; Databases; Deterioration; Development; Eligibility Determination; End stage renal failure; Epidemiologic Studies; Epidemiology; Ethnic Origin; Evaluation; Event; Exclusion; Exclusion Criteria; Foundations; Funding; Future; Glomerular Filtration Rate; Goals; Health; Hispanics; Hour; Hypertension; Incidence; Individual; Informed Consent; Kidney; Kidney Diseases; Kidney Failure; Life; Lipids; Living Donors; Long-Term Effects; Longitudinal Studies; Low Prevalence; Master of Science; Measurement; Measures; Medical; Medical center; Mentors; Mentorship; Minority; Monitor; Nephrectomy; Outcome; Pattern; Phenotype; Policies; Population; Population Control; Population Heterogeneity; Predisposition; Presbyterian Church; Principal Investigator; Process; Prospective Studies; Race; Renal function; Reporting; Research; Research Personnel; Risk; Risk Factors; Sample Size; Testing; Training; Transplantation; United States; Urine; Visit; base; cardiovascular risk factor; clinical phenotype; comparison group; evidence base; experience; follow-up; high risk; improved; insight; meetings; patient oriented research; programs; statistics; urinary

DESCRIPTION (provided by applicant): In the past decade, as the incidence of end-stage renal disease has grown and the number of cadaveric kidneys has remained stagnant, there has been a dramatic increase in the use of living kidney donors. Several studies and our preliminary data have demonstrated a subset of donors with unexpectedly poor renal function post-donation. These donors thus meet criteria for chronic kidney disease (CKD). The clinical implications of low GFR in living donors is unclear, however epidemiologic studies have found that individuals with CKD have a greater deterioration in renal function and a greater number of cardiovascular (CV) events; this also coincides with the increased presence of markers of renal and CV risk. We hypothesize that kidney donation confers an increased risk of long-term renal and cardiovascular complications in a subset of donors who develop a low GFR post-donation. We further hypothesize that there are specific risk factors for developing a low GFR post-donation that are readily identifiable prior to donation. To test these hypotheses, we propose 2 complementary studies: 1. A retrospective/cross-sectional study of donors between 1 and 6 years post-donation. 2. A prospective study of donors and non-donor controls, followed for up to 5 years. We will examine risk factors for renal progression and CV events in living donors to determine whether GFR <60 places donors at increased risk. These will include ambulatory blood pressure, urinary microalbumin, lipid profile, C-reactive protein, and endothelial function. This will provide early data about possible future risks in this subset of donors, and offer insight into the mechanisms of risk in CKD. Donor phenotypes that may increase the risk of low post-donation GFR have not been well-explored, and have not been evaluated in a racially and ethnically diverse population. We will assess potential predictors of a post-donation GFR of <60, including race, ethnicity, pre-donation blood pressure, and pre-donation body mass index. This information may be used to establish evidence-based exclusion criteria for donation and to improve the informed consent process. This study of living kidney donors will supply valuable information on the medical risks of uninephrectomy in a diverse population, and will contribute to the development of data-driven policies for living kidney donation. The primary purpose of this application is to support the candidate, Dr. Elizabeth Ommen as she develops into an independent investigator in the areas of renal disease and hypertension, with an emphasis on minority populations. She will supplement the formal training in clinical research that she has already received with more advanced courses in epidemiology and statistics. Her mentors will use their research

描述（由申请人提供）： 在过去的十年中，随着末期肾脏疾病的发病率已经增加，尸体肾脏数量仍然停滞，因此使用活肾脏供体的使用急剧增加。几项研究和我们的初步数据表明，在演讲后肾功能出乎意料的供体的一部分。因此，这些供体符合慢性肾脏疾病（CKD）的标准。低GFR在活体捐助者中的临床意义尚不清楚，但是流行病学研究发现，CKD的个体在肾功能上的恶化较大，心血管（CV）事件越来越多。这也与肾脏和简历风险标记的存在增加相吻合。我们假设肾脏捐赠赋予了长期肾脏和心血管并发症的风险增加，因为捐助后的一部分捐助者会出现较低的GFR。我们进一步假设，在捐赠前很容易识别出较低的GFR后，有一些特定的风险因素。为了检验这些假设，我们提出了2项互补研究： 1。捐赠后1至6年之间的回顾/横断面研究。 2。对捐助者和非持有人对照的前瞻性研究，最多可长达5年。 我们将研究活捐赠者中肾脏进展和简历事件的危险因素，以确定GFR <60 <60的捐助者是否会使风险增加。这些将包括卧床血压，尿微量白蛋白，脂质谱，C反应蛋白和内皮功能。这将提供有关捐助者子集中可能未来风险的早期数据，并提供有关CKD风险机制的见解。 可能会增加降级后GFR风险的供体表型尚未得到充分探索，也没有在种族和种族多样化的人群中进行评估。我们将评估持续后GFR的潜在预测指标，包括种族，种族，献血前血压和分配前体重指数。该信息可用于建立捐赠的基于证据的排除标准并改善知情同意程序。 这项对活肾脏捐助者的研究将提供有关多元化人群中单阶段切除术的医疗风险的有价值信息，并将有助于制定以数据驱动的生活肾脏捐赠政策。 本申请的主要目的是支持候选人伊丽莎白·奥姆森（Elizabeth Ommen）博士，因为她发展成为肾脏疾病和高血压领域的独立研究者，重点是少数人。她将补充她已经收到的临床研究的正式培训，这些培训已经获得了流行病学和统计学的更高级课程。她的导师将使用他们的研究