AJKD：活体供肾者发生骨折的危险性
2012-07-16 范振光 美国肾脏病杂志
CKD疾病会增加患者发生骨折的几率，捐肾者失去了正常50%的肾脏体积，其钙离子平衡会出现改变。 研究者对加拿大安大略1992-2009年一共2015名成人捐肾者资料进行回顾分析，同时从正常健康人群中选取20150名作为对照组，平均年龄在43岁，平均随访时间为6.6年，最长17.7年。统计结果显示捐肾者发生骨折的几率并没有高于对照组，多因素加入的分析结果也是未见显著差异；而年龄稍高的成年人接
CKD疾病会增加患者发生骨折的几率，捐肾者失去了正常50%的肾脏体积，其钙离子平衡会出现改变。
研究者对加拿大安大略1992-2009年一共2015名成人捐肾者资料进行回顾分析，同时从正常健康人群中选取20150名作为对照组，平均年龄在43岁，平均随访时间为6.6年，最长17.7年。统计结果显示捐肾者发生骨折的几率并没有高于对照组，多因素加入的分析结果也是未见显著差异；而年龄稍高的成年人接受二碳磷酸盐化合物治疗后则存在一点差异（17.1% vs 15.2%；P=0.4）。
这些统计结果提示了捐肾者发生骨折的几率并不比正常人高，这将对我们预防骨折的治疗安全提出了新的观点。
原始文献：
Garg AX, et al. Fracture risk in living kidney donors: a matched cohort study.Am J Kidney Dis 2012 Jun;59(6):770-6 PMID:22472209
BACKGROUND:
Chronic kidney disease increases the risk of bone fragility fractures (osteoporotic fractures). Living kidney donors lose 50% of their renal mass and show changes in calcium homeostasis. We studied whether living kidney donation increases the risk of fragility fracture.
DESIGN:
Retrospective matched-cohort study.
SETTING & PARTICIPANTS:
We reviewed the medical charts of all 2,015 adults in Ontario, Canada, who donated a kidney between 1992 and 2009 (surgeries performed across 5 transplant programs). We linked this information to health care databases and randomly selected 20,150 matched nondonors from the healthiest portion of the general population. Median age was 43 (95% CI, 24-50) years at study enrollment. Donors and nondonors were then followed up for a median of 6.6 years and a maximum of 17.7 years.
PREDICTOR:
Living donor nephrectomy.
OUTCOMES:
The primary outcome was lower- and upper-extremity fragility fractures. Individuals who reached 66 years or older in follow-up had bisphosphonate prescriptions recorded.
RESULTS:
The rate of fragility fracture was no higher in donors compared with nondonors (16.4 vs 18.7 events/10,000 person-years; rate ratio, 0.88; 95% CI, 0.58-1.32). Results were similar in multiple additional analyses. There was little difference in the proportion of older adults in follow-up who received a bisphosphonate prescription (17.1% vs 15.2%; P = 0.4).
LIMITATIONS:
These are interim results. Ongoing surveillance of this and other donor cohorts is warranted to be sure an association does not manifest with longer follow-up.
CONCLUSIONS:
To date, there is no evidence of increased fragility fracture risk in living kidney donors. Our results meet an information need and are reassuring for the safety of the practice.
作者：范振光
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