101
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Garg N, Lentine KL, Inker LA, Garg AX, Rodrigue JR, Segev DL, Mandelbrot DA. The kidney evaluation of living kidney donor candidates: US practices in 2017. Am J Transplant 2020; 20:3379-3389. [PMID: 32342620 DOI: 10.1111/ajt.15951] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/25/2023]
Abstract
We surveyed US transplant programs to assess practices used to assess kidney health in living kidney donor candidates in 2017; the response rate was 31%. In this report, we focus on the kidney; a companion piece focuses on the metabolic and cardiovascular aspects of candidate evaluation. Compared to 2005, programs have become more stringent in accepting younger candidates and less stringent in accepting older candidates. The 24-hour creatinine clearance remains the mainstay for kidney function assessment, with 74% continuing to use a value below 80 mL/min/1.73 m2 for exclusion and 22% using age-based criteria. ApoL1 genotyping is obtained routinely or selectively by 45%, half of which use the high-risk genotype as an absolute exclusion criterion. For history of symptomatic stones, 49% accept if there is no current radiographic evidence of stones and urine profile is low risk, 80%-95% consider candidates with unilateral asymptomatic stones, but only 33%-48% consider if stones are bilateral. In addition, 14% use the risk assessment tool developed by Grams et al routinely for decision-making, and 42% use it sometimes. Also, 57% reported not having yet determined a risk threshold for acceptable postdonation risk above which candidates are excluded. Contemporary practice variation underscores the need for better evidence to guide the donor selection process.
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Affiliation(s)
- Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Wisconsin, USA
| | - Lesley A Inker
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - James R Rodrigue
- Beth Israel Deaconess Medical Center, Transplant Institute, Boston, Massachusetts, USA.,Departments of Surgery and Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
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102
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Neugarten J. Gender and the Progression of Chronic Kidney Disease. Mayo Clin Proc 2020; 95:2582-2584. [PMID: 33276828 DOI: 10.1016/j.mayocp.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Joel Neugarten
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
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103
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Garg N, Lentine KL, Inker LA, Garg AX, Rodrigue JR, Segev DL, Mandelbrot DA. Metabolic, cardiovascular, and substance use evaluation of living kidney donor candidates: US practices in 2017. Am J Transplant 2020; 20:3390-3400. [PMID: 32342601 DOI: 10.1111/ajt.15964] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/25/2023]
Abstract
We surveyed US transplant centers to assess practices regarding the evaluation and selection of living kidney donors based on metabolic, cardiovascular, and substance use risk factors. Our companion article describes renal aspects of the evaluation. Response rate was 31%. Compared with 2005, programs have become more accepting of hypertensive candidates: 65% in 2017% vs 41% in 2005 consider candidates with hypertension well controlled with 1 medication. One notable exception is black hypertensive candidates, who are frequently excluded regardless of severity. The most common body mass index (BMI) cutoff remains 35 kg/m2 , and fewer programs now consider candidates with BMI >40 kg/m2 . A 2-hour oral glucose tolerance test of ≥140 mg/dL remains the most common criterion for exclusion of prediabetic candidates. One quarter to one third of programs exclude based on isolated cardiac abnormalities, such as mild aortic stenosis; a similar proportion consider these candidates only if older than 50 years. Cigarette or marijuana smoking are infrequently criteria for exclusion, although 45% and 37% programs, respectively, require cessation 4 weeks prior to surgery. In addition to providing an overview of current practices in living kidney donor evaluation, our study highlights the importance of research evaluating outcomes with various comorbidities to guide practice.
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Affiliation(s)
- Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Lesley A Inker
- Division of Nephrology, Department of Medicine, Tufts Medical Center Boston, Boston, Massachusetts, USA
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - James R Rodrigue
- Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Departments of Surgery and Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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104
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Murata M, Takeda A, Ootsuka Y, Shinjo H, Ito C, Watanabe Y, Washino M, Nakano Y, Tomosugi T, Futamura K, Okada M, Hiramitsu T, Goto N, Ichimori T, Narumi S, Watarai Y, Nishihira M, Morozumi K. Study of Glomerulopathy in Donors after Kidney Transplantation. Nephron Clin Pract 2020; 144 Suppl 1:86-90. [PMID: 33254170 DOI: 10.1159/000512137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Living kidney donation improves the lives of individuals with kidney failure; however, recent studies have suggested that living kidney donors may be at a relatively higher risk of reduced renal function than healthy non-donors. We therefore aimed to evaluate the clinical and pathological findings in living kidney donors who developed kidney disease. METHODS From January 1991 to May 2019, 1,625 live kidney donations were performed at our hospital. Among the donors, 7 developed kidney disease after donation and underwent open renal biopsy. We studied the clinical and pathological findings of these patients from their clinical records. RESULTS There were 3 patients with immunoglobulin A (IgA) nephropathy, 2 with membranous nephropathy, 1 with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis, and 1 with secondary focal segmental glomerulosclerosis (FSGS). All patients with IgA nephropathy had latent IgA deposition on their baseline biopsy. One patient with membranous nephropathy demonstrated findings of membranous nephropathy on the baseline biopsy, despite being asymptomatic. All patients, except for those with ANCA-associated nephropathy and secondary FSGS, recovered from the nephritis or maintained an adequate renal function after treatment. DISCUSSION/CONCLUSION Baseline biopsy is necessary for assessing the renal condition of kidney donors, and these donors require long-term follow-up based on their baseline biopsy findings. If donors develop kidney disease, appropriate diagnosis and treatment are essential.
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Affiliation(s)
- Minako Murata
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan,
| | - Asami Takeda
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yasuhiro Ootsuka
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Hibiki Shinjo
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Chiharu Ito
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yu Watanabe
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Masaya Washino
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yutaka Nakano
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Toshihide Tomosugi
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Norihiko Goto
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Toshihiro Ichimori
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Shunji Narumi
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yoshihiko Watarai
- Department of Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Morikuni Nishihira
- Department of Renal Transplantation, Masuko Memorial Hospital, Nagoya, Japan
| | - Kunio Morozumi
- Department of Renal Transplantation, Masuko Memorial Hospital, Nagoya, Japan
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105
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Ammary FA, Yu Y, Ferzola A, Motter JD, Massie AB, Yu S, Thomas AG, Crews DC, Segev DL, Muzaale AD, Henderson ML. The first increase in live kidney donation in the United States in 15 years. Am J Transplant 2020; 20:3590-3598. [PMID: 32524764 PMCID: PMC8717834 DOI: 10.1111/ajt.16136] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 01/25/2023]
Abstract
The first sustained increase in live kidney donation in the United States in 15 years was observed from 2017 to 2019. To help sustain this surge, we studied 35 900 donors (70.3% white, 14.5% Hispanic, 9.3% black, 4.4% Asian) to understand the increase in 2017-2019 vs 2014-2016 using Poisson regression. Among biologically related donors aged <35, 35-49, and ≥50 years, the number of donors did not change across race/ethnicity but increased by 38% and 29% for Hispanic and black ≥50. Among unrelated donors <35, 35-49, and ≥50, white donors increased by 18%, 14%, and 27%; Hispanic donors <35 did not change but increased by 22% and 35% for 35-49 and ≥50; black donors <35 declined by 23% and did not change for 35-49 and ≥50; Asian donors did not change. Among kidney paired donors <35, 35-49, and ≥50, white donors increased by 42%, 50%, and 68%; Hispanic donors <35 and 35-49 increased by 36% and 55% and did not change for ≥50; black donors did not change; Asian donors <35 did not change but increased by 107% and 82% for 35-49 and ≥50. The increase in donation was driven predominantly by unrelated and paired white donors. Donation among unrelated black individuals should be promoted.
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Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yifan Yu
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Alexander Ferzola
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer D. Motter
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Scientific Registry of Transplant Recipients, Minneapolis, MN
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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106
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Altheaby A, Alharbi N, Alzamil A, Alzahrani E, Alshaia AM, Aldowsary B, Aboalsamah G, Farooqui M, Bin Saad K, Arabi Z. How Does the Remaining Single Kidney Cope After Contralateral Nephrectomy of the Kidney Donor? A Single-Center Cohort Study. Cureus 2020; 12:e11491. [PMID: 33335820 PMCID: PMC7737237 DOI: 10.7759/cureus.11491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Immediately after kidney donation, the remaining kidney will undergo hyperfiltration and work at a higher level to compensate for the other kidney's loss. It is estimated that 70% of the baseline renal function before the donation is recovered post-donation. However, factors that determine the post-donation renal compensation are not well understood. Methods We conducted a retrospective study of 190 consecutive kidney donors who completed a one-year follow-up in order to predict the factors affecting the function of the remaining kidney post-contralateral nephrectomy. Results We enrolled 190 living kidney donors who had completed at least one year of follow-up after nephrectomy. Among the participants, 149 (78.4%) were males and 41 (21.6%) were females. The mean age of the participants was 31.33 ±7.9 years and the mean body mass index (BMI) was 25.6 ±3.9 kg/m2. Before kidney donation, the mean estimated glomerular filtration rate (eGFR) and serum creatinine were 114.31 ±15.94 ml/min/1.73 m2 and 71.60 ±10.62 mmol/min, respectively. At the one-year follow-up, the mean eGFR was 77.97 ±14.44 ml/min/1.73 m2 and serum creatinine was 100.84 ±20.15 mmol/min. The female gender [odds ratio (OR): 20.6, 95% CI: 3.9-107.7, p: <0.001] and having a higher baseline eGFR (OR: 8.8, 95% CI: 1.6-45.8, p = 0.01) were found to be significant predictors of having a better eGFR at one year post-nephrectomy. Conclusions Female gender and pre-donation low serum creatinine and high eGFR were the significant predictors of better kidney function at one year post-contralateral nephrectomy. However, further studies with longer follow-up durations are needed to better assess the factors that could predict renal compensation and the renal compensation rate's suitability as a prognostic measure for long-term renal outcomes.
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Affiliation(s)
- Abdulrahman Altheaby
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, SAU
| | - Nouf Alharbi
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Alaa Alzamil
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Elham Alzahrani
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abeer M Alshaia
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Basayl Aldowsary
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, SAU
| | - Ghaleb Aboalsamah
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, SAU
| | - Mahfooz Farooqui
- Nephrology, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, SAU
| | - Khaled Bin Saad
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, SAU
| | - Ziad Arabi
- Division of Adult Transplant Nephrology, Department of Organ Transplant Center, King Abulaziz Medical City, Riyadh, SAU
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107
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Franquet Q, Matillon X, Terrier N, Rambeaud JJ, Crouzet S, Long JA, Fassi-Fehri H, Codas-Duarte R, Poncet D, Jouve T, Noble J, Malvezzi P, Rostaing L, Descotes JL, Badet L, Fiard G. The Mayo Adhesive Probability score can help predict intra- and postoperative complications in patients undergoing laparoscopic donor nephrectomy. World J Urol 2020; 39:2775-2781. [PMID: 33175210 DOI: 10.1007/s00345-020-03513-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Living donor nephrectomy is a high-stake procedure involving healthy individuals, therefore every effort should be made to define each patient's individualized risk and improve potential donors' information. The aim of this study was to evaluate the interest of the Mayo adhesive probability (MAP) score, an imaging-based score initially designed to estimate the risk of adherent perinephric fat in partial nephrectomy, to predict intra- and postoperative complications of living donor nephrectomy. MATERIALS AND METHODS We retrospectively reviewed the imaging, clinical, and follow-up data of 452 kidney donors who underwent laparoscopic donor nephrectomy in two academic centers. RESULTS Imaging and follow-up data were available for 307 kidney donors, among which 44 (14%) had a high MAP score (≥ 3). Intraoperative difficulties were encountered in 50 patients (16%), including difficult dissection (n = 35) and bleeding (n = 17). Conversion to open surgery was required for 13 patients (4.2%). On multivariate analysis, a MAP score ≥ 3 was significantly associated with the risk of intraoperative difficulty [OR 14.12 (5.58-35.7), p < 0.001] or conversion to open surgery [OR 18.96 (3.42-105.14), p = 0.0042]. Postoperative complications were noted in 99 patients (32%), including 12 patients (3.9%) with Clavien-Dindo grade III-IV complications. On multivariate analysis, a high MAP score was also associated with the risk of postoperative complications [OR 2.55 (1.20-5.40), p = 0.01]. CONCLUSIONS In this retrospective bicentric study, a high MAP score was associated with the risk of intra- and postoperative complications of laparoscopic donor nephrectomy. The MAP score appears of interest in the living donor evaluation process to help improve donors' information and outcomes.
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Affiliation(s)
- Quentin Franquet
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Xavier Matillon
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Terrier
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Jean-Jacques Rambeaud
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Sebastien Crouzet
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Alexandre Long
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France.,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France
| | - Hakim Fassi-Fehri
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ricardo Codas-Duarte
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Delphine Poncet
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Thomas Jouve
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Johan Noble
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Paolo Malvezzi
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Lionel Rostaing
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Luc Descotes
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France.,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France
| | - Lionel Badet
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Gaelle Fiard
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France. .,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France.
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108
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Levan ML, Waldram MM, DiBrito SR, Thomas AG, Al Ammary F, Ottman S, Bannon J, Brennan DC, Massie AB, Scalea J, Barth RN, Segev DL, Garonzik-Wang JM. Financial incentives versus standard of care to improve patient compliance with live kidney donor follow-up: protocol for a multi-center, parallel-group randomized controlled trial. BMC Nephrol 2020; 21:465. [PMID: 33167882 PMCID: PMC7654057 DOI: 10.1186/s12882-020-02117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Live kidney donors (LKDs) account for nearly a third of kidney transplants in the United States. While donor nephrectomy poses minimal post-surgical risk, LKDs face an elevated adjusted risk of developing chronic diseases such as hypertension, diabetes, and end-stage renal disease. Routine screening presents an opportunity for the early detection and management of chronic conditions. Transplant hospital reporting requirements mandate the submission of laboratory and clinical data at 6-months, 1-year, and 2-years after kidney donation, but less than 50% of hospitals are able to comply. Strategies to increase patient engagement in follow-up efforts while minimizing administrative burden are needed. We seek to evaluate the effectiveness of using small financial incentives to promote patient compliance with LKD follow-up. METHODS/DESIGN We are conducting a two-arm randomized controlled trial (RCT) of patients who undergo live donor nephrectomy at The Johns Hopkins Hospital Comprehensive Transplant Center (MDJH) and the University of Maryland Medical Center Transplant Center (MDUM). Eligible donors will be recruited in-person at their first post-surgical clinic visit or over the phone. We will use block randomization to assign LKDs to the intervention ($25 gift card at each follow-up visit) or control arm (current standard of care). Follow-up compliance will be tracked over time. The primary outcome will be complete (all components addressed) and timely (60 days before or after expected visit date), submission of LKD follow-up data at required 6-month, 1-year, and 2-year time points. The secondary outcome will be transplant hospital-level compliance with federal reporting requirements at each visit. Rates will be compared between the two arms following the intention-to-treat principle. DISCUSSION Small financial incentivization might increase patient compliance in the context of LKD follow-up, without placing undue administrative burden on transplant providers. The findings of this RCT will inform potential center- and national-level initiatives to provide all LKDs with small financial incentives to promote engagement with post-donation monitoring efforts. TRIAL REGISTRATION ClinicalTrials.gov number: NCT03090646 Date of registration: March 2, 2017 Sponsors: Johns Hopkins University, University of Maryland Medical Center Funding: The Living Legacy Foundation of Maryland.
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Affiliation(s)
- Macey L. Levan
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD USA
| | - Madeleine M. Waldram
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Sandra R. DiBrito
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Alvin G. Thomas
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC USA
| | - Fawaz Al Ammary
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Shane Ottman
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Jaclyn Bannon
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Daniel C. Brennan
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Allan B. Massie
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Joseph Scalea
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD USA
| | - Rolf N. Barth
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD USA
| | - Dorry L. Segev
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Jacqueline M. Garonzik-Wang
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
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109
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van Londen M, van der Weijden J, de Borst MH. Identifying donors with no recovery of kidney function. Kidney Int 2020; 98:1349-1350. [PMID: 33126982 DOI: 10.1016/j.kint.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
| | - Jessica van der Weijden
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Martin H de Borst
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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110
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Abstract
PURPOSE OF REVIEW To summarize the current state of evidence regarding the role of apolipoprotein L1 (APOL1) genotyping in evaluating donors for kidney transplantation. RECENT FINDINGS African ancestry is associated with an increased risk of kidney failure following living donation. Moreover, kidney transplants from African ancestry deceased donors have an increased risk of graft failure. Preliminary evidence suggests that APOL1 genotype may mediate at least a portion of this racial variation, with high-risk APOL1 genotypes defined by presence of two renal risk variants (RRVs). A pilot study 136 African ancestry living donors found that those with APOL1 high-risk genotypes had lower baseline kidney function and faster rates of kidney function decline after donation. To date, three retrospective studies identified a two-to-three times greater risk of allograft failure associated with kidneys from donors with high-risk APOL1 genotype. Active research initiatives seek to address unanswered questions, including reproducibility in large national samples, the role of 'second hits' injuries, and impact of recipient genotype, with a goal to build consensus on applications for policy and practice. SUMMARY As evidence evolves, APOL1 genotyping may have applications for organ quality scoring in deceased donor kidney allocation, and for the evaluation and selection of living donor candidates.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Roslyn B Mannon
- Division of Nephrology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Zingerman B, Erman A, Mashraki T, Chagnac A, Rozen-Zvi B, Rahamimov R. Association of obesity and muscle mass with risk of albuminuria in renal transplant recipients. J Nephrol 2020; 34:1315-1325. [PMID: 33098523 DOI: 10.1007/s40620-020-00883-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/28/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Increased albuminuria is a predictor of graft loss in kidney graft recipients. It is unknown whether obesity is an independent risk factor for the development of increased albuminuria in this population. The aim of this study was to elucidate the association between obesity and albuminuria in renal transplant recipients. METHODS We enrolled 330 renal transplant recipients and prospectively collected demographic, anthropomorphic, clinical and laboratory variables susceptible to influence albumin excretion. The outcome was albuminuria, measured using accurately timed urine collections. Data from 201 patients were analyzed after exclusion of participants with missing data and patients enrolled less than 6 months since renal transplantation. Analysis was carried out for an early and a late period, defined according to the 2.4-year median follow-up time. RESULTS Body mass index (BMI), waist circumference and urinary creatinine excretion rate were independent predictors of albuminuria in the late post-transplant period, indicating that the predictive value of body mass index for albuminuria is related to both increased abdominal fat mass and increased muscle mass. BMI was an independent predictor of microalbuminuria. Waist circumference and urinary creatinine were independent predictors of microalbuminuria for values above certain cutoffs: 110% of the accepted thresholds defining abdominal obesity and 1500 mg/day, respectively. CONCLUSIONS These associations, which have not previously been reported, suggest, but do not prove, that an imbalance between metabolic demand and nephron mass may be responsible for increased albuminuria in the renal transplant population.
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Affiliation(s)
- Boris Zingerman
- Department of Nephrology and Hypertension, Rabin Medical Center, 4941492, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Erman
- Department of Nephrology and Hypertension, Rabin Medical Center, 4941492, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tiki Mashraki
- Department of Nephrology and Hypertension, Rabin Medical Center, 4941492, Petah Tikva, Israel
| | - Avry Chagnac
- Department of Nephrology and Hypertension, Rabin Medical Center, 4941492, Petah Tikva, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Benaya Rozen-Zvi
- Department of Nephrology and Hypertension, Rabin Medical Center, 4941492, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Rahamimov
- Department of Nephrology and Hypertension, Rabin Medical Center, 4941492, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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112
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Schuster A, Franke P, Steines L, Zecher D, Hackl C, Werner J, Bergler T, Banas B. Safe Long-Term Outcome After Kidney Donation in Older Donors: A Single-Center Experience. Ann Transplant 2020; 25:e924235. [PMID: 33004786 PMCID: PMC7537478 DOI: 10.12659/aot.924235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Declining numbers of deceased donors and prolonged waiting time emphasize the importance of living kidney donation. Furthermore, because of the changing age structures with increasingly older recipients, the question of acceptance of older donors is becoming more relevant. However, sufficient long-term outcome data, especially for older donors – including histopathological analysis – are lacking. The aim of this study was to analyze the Regensburg Living Donor Cohort with regard to age <65 and ≥65 years, with a 10-year follow-up to identify attributable risk factors. Material/Methods All donors were analyzed for renal, cardiovascular, and pre-existing conditions at baseline and at follow-up. They were studied for predefined renal and additional end-points, eg cardiovascular ones and various stratifications such as estimated glomerular filtration rate (eGFR). Additionally, as a unique feature in such an analysis, a histopathological workup of pre-existing chronic lesions of the donated kidneys was added. Results On average, donors in the group <65 years were 50 years old at the time of donation compared with 68 years in the older group. Creatinine at baseline was 0.8 mg/dl in both groups, corresponding to an eGFR of 96.8±12.8 ml/min (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and 83.7±10.3 ml/min (CKD-EPI). In the follow-up, donors ≥65 years showed a statistically significantly worse eGFR and a greater eGFR decline, being accompanied by more pronounced chronic histopathological lesions, eg glomerulopathy, than the control group. However, this was largely constant over the entire observation period and no donor developed an end-stage renal disease or an eGFR below 30 ml/min. Conclusions To summarize, living kidney donation after an intensive screening is safe even for older donors; however, a precise aftercare to ensure balanced risk profile for living donors is mandatory.
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Affiliation(s)
- Antonia Schuster
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Paula Franke
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Louisa Steines
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Zecher
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Christina Hackl
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Jens Werner
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Bergler
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Banas
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
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113
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Is obesity a contraindication for kidney donation? Surg Endosc 2020; 34:4632-4637. [PMID: 31637602 DOI: 10.1007/s00464-019-07218-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION To enlarge the donor pool, kidney donors with obesity have been considered. We hypothesized that it is safe for patients with obesity to serve as living kidney donors. METHODS In this single-center retrospective analysis, we examined the effect of obesity (body mass index (BMI) of 30-35 kg/m2) on glomerular filtration rate (GFR) and creatinine in patients undergoing laparoscopic donor nephrectomy. Other outcomes included intraoperative, 30-, and 90-day complications. We examined the trajectory between patients with obesity versus patients without obesity over time using mixed effects models for the outcomes of creatinine in mg/dL and GFR in mL/min/1.73 m2. RESULTS: Among donors with obesity versus donors without obesity, there were no significant differences in demographics or comorbidities. Baseline creatinine in donors with obesity was significantly greater than that of donors without obesity (p = 0.02). Operative time was significantly longer in donors with obesity versus without obesity (p = 0.03). There was no significant difference in 30-day morbidity between donors with obesity versus without obesity (6.52 vs. 3.57%, respectively; p = 0.38). The rate of graft complications was 8.7% in donors with obesity versus 7.1% in donors without obesity (p = 1.0). 90-day complications were infrequent, and not significant different between the groups. At 6, 12, and 24-month postoperative follow-up, the mean creatinine level in patients with obesity was not significantly different from that of patients without obesity (1.23 vs. 1.31, 1.23 vs. 1.26, and 1.17 vs. 1.19 at 6, 12, and 24 months, respectively). Mean GFR was also not significantly different at 6, 12, and, 24 months. CONCLUSION Postoperative creatinine and GFR changes were not significantly different in patients with obesity versus without obesity after laparoscopic donor nephrectomy. These findings suggest that carefully screened living kidney donors with obesity do not experience decreased postoperative renal function.
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Mena-Gutierrez AM, Reeves-Daniel AM, Jay CL, Freedman BI. Practical Considerations for APOL1 Genotyping in the Living Kidney Donor Evaluation. Transplantation 2020; 104:27-32. [PMID: 31449181 DOI: 10.1097/tp.0000000000002933] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Association between the apolipoprotein L1 gene (APOL1) and nephropathy has altered the epidemiology of chronic kidney disease. In addition, donor APOL1 genotypes play important roles in the time to allograft failure in kidneys transplanted from deceased donors and the safety of living kidney donation. METHODS This article reviews genetic testing for inherited kidney disease in living kidney donors to improve donor safety. APOL1 genotyping in donors with recent African ancestry is considered. RESULTS Based on current data, transplant physicians should discuss APOL1 genotyping with potential living kidney donors self-reporting recent African ancestry. Until results from APOL1 Long-term Kidney Transplant Outcomes Network ancillary studies are available, we present practical approaches from our experience for considering APOL1 genotyping in the living donor evaluation. CONCLUSIONS Transplant physicians should inform potential living kidney donors at risk for APOL1-associated nephropathy about the gene and possibility of genetic testing early in the donor evaluation, well before scheduling the donor nephrectomy. Transplant programs must weigh risks of performing a donor nephrectomy in those with 2 APOL1 renal risk variants (high-risk genotypes), particularly younger individuals. Our program counsels kidney donors with APOL1 high-risk genotypes in the same fashion as with risk genotypes in other nephropathy genes. Because most African American kidney donor candidates lacking hypertension, proteinuria and reduced kidney function after workup will not possess APOL1 high-risk genotypes, genetic testing is unlikely to markedly increase donor declines and may reassure donors with regard to their long-term kidney outcomes, potentially increasing the number of African American donors.
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Affiliation(s)
- Alejandra M Mena-Gutierrez
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amber M Reeves-Daniel
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Colleen L Jay
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Barry I Freedman
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
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Performance of Creatinine Clearance and Estimated GFR in Assessing Kidney Function in Living Donor Candidates. Transplantation 2020; 104:575-582. [PMID: 31205262 DOI: 10.1097/tp.0000000000002797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Glomerular filtration rate (GFR) assessment is a key aspect in the evaluation of living kidney donor candidates; however, data on performance of commonly used methods are limited. METHODS We examined 769 living kidney donor candidates with 24-hour urine collections assessed as accurate by comparing measured creatinine excretion rate (CER) to CER estimated using a 4-variable equation previously developed and validated using robust methodology. RESULTS Of all collections, 42.6% would have been deemed inaccurate, mostly under-collections, using the conventional weight- and gender-based CER estimation. Creatinine clearance (CrCl) overestimated I-iothalamate GFR (iGFR), estimated GFR (eGFR), underestimated iGFR, and their average [Avg (CrCl and eGFR)] essentially eliminated the GFR bias (median bias = +2.2, -5.4, and -1.0 mL/min/1.73 m, respectively; P < 0.001). This held true for all subgroups except blacks, where all 3 measures overestimated iGFR. Avg (CrCl and eGFR) also offered modestly improved accuracy compared with CrCl alone, as measured by the proportion of values falling within 10% (50.7% versus 45.3%; P = 0.009) and 30% of iGFR (94.5% versus 89.3%; P < 0.001). CONCLUSIONS When measured GFR is unavailable, the Avg (CrCl and eGFR) provides a better estimate of kidney function in kidney donor candidates than either measure alone, although in blacks the estimates are neither better nor worse.
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Sumida K, Nadkarni GN, Grams ME, Sang Y, Ballew SH, Coresh J, Matsushita K, Surapaneni A, Brunskill N, Chadban SJ, Chang AR, Cirillo M, Daratha KB, Gansevoort RT, Garg AX, Iacoviello L, Kayama T, Konta T, Kovesdy CP, Lash J, Lee BJ, Major RW, Metzger M, Miura K, Naimark DMJ, Nelson RG, Sawhney S, Stempniewicz N, Tang M, Townsend RR, Traynor JP, Valdivielso JM, Wetzels J, Polkinghorne KR, Heerspink HJL. Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis : An Individual Participant-Based Meta-analysis. Ann Intern Med 2020; 173:426-435. [PMID: 32658569 PMCID: PMC7780415 DOI: 10.7326/m20-0529] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or dipstick protein is often measured instead. OBJECTIVE To develop equations for converting urine protein-creatinine ratio (PCR) and dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging. DESIGN Individual participant-based meta-analysis. SETTING 12 research and 21 clinical cohorts. PARTICIPANTS 919 383 adults with same-day measures of ACR and PCR or dipstick protein. MEASUREMENTS Equations to convert urine PCR and dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g). RESULTS Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR. LIMITATION Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample. CONCLUSION Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis. PRIMARY FUNDING SOURCE National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.
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Affiliation(s)
- Keiichi Sumida
- University of Tennessee Health Science Center, Memphis, Tennessee (K.S.)
| | - Girish N Nadkarni
- Icahn School of Medicine at Mount Sinai, New York, New York (G.N.N.)
| | - Morgan E Grams
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Yingying Sang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Shoshana H Ballew
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Aditya Surapaneni
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Nigel Brunskill
- Leicester General Hospital, University Hospitals of Leicester NHS Trust, and University of Leicester, Leicester, United Kingdom (N.B., R.W.M.)
| | - Steve J Chadban
- Royal Prince Alfred Hospital and Kidney Node, University of Sydney, Sydney, New South Wales, Australia (S.J.C.)
| | - Alex R Chang
- Geisinger Health, Danville, Pennsylvania (A.R.C.)
| | | | - Kenn B Daratha
- Providence Sacred Heart Medical Center and Gonzaga University School of Anesthesia, Spokane, Washington (K.B.D.)
| | - Ron T Gansevoort
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (R.T.G.)
| | - Amit X Garg
- ICES and Western University, London, Ontario, Canada (A.X.G.)
| | - Licia Iacoviello
- IRCCS Neuromed, Pozzilli, Italy, and University of Insubria, Varese, Italy (L.I.)
| | | | - Tsuneo Konta
- Yamagata University, Yamagata, Japan (T.K., T.K.)
| | - Csaba P Kovesdy
- Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee (C.P.K.)
| | - James Lash
- University of Illinois at Chicago, Chicago, Illinois (J.L.)
| | - Brian J Lee
- Kaiser Permanente, Hawaii Region, and Moanalua Medical Center, Honolulu, Hawaii (B.J.L.)
| | - Rupert W Major
- Leicester General Hospital, University Hospitals of Leicester NHS Trust, and University of Leicester, Leicester, United Kingdom (N.B., R.W.M.)
| | - Marie Metzger
- Paris Saclay University, Paris-Sud University, UVSQ, CESP, INSERM U1018, Villejuif, France (M.M.)
| | - Katsuyuki Miura
- Shiga University of Medical Science Seta-Tsukinowa-cho, Shiga, Japan (K.M.)
| | - David M J Naimark
- Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada (D.M.N.)
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona (R.G.N.)
| | | | | | - Mila Tang
- University of British Columbia, Vancouver, British Columbia, Canada (M.T.)
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (R.R.T.)
| | - Jamie P Traynor
- Queen Elizabeth University Hospital, Glasgow, Scotland (J.P.T.)
| | - José M Valdivielso
- Institute of Biomedical Research of Lleida and Spanish Research Network for Renal Diseases, Lleida, Spain (J.M.V.)
| | - Jack Wetzels
- Radboud University Medical Center, Nijmegen, the Netherlands (J.W.)
| | | | - Hiddo J L Heerspink
- University of Groningen, University Medical Center, Groningen, the Netherlands, and The George Institute for Global Health, Sydney, New South Wales, Australia (H.J.H.)
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Zhang WJ, Wang ZY, Zhou WX, Yang NQ, Wang Y, Tang Y, Zhou XC, Dao JC, Ma YR, He YP, Wang XL, Wang WG, Yang L. Identifying risk factors for chronic kidney disease stage 3 in adults with acquired solitary kidney from unilateral nephrectomy: a retrospective cohort study. BMC Nephrol 2020; 21:397. [PMID: 32928128 PMCID: PMC7491083 DOI: 10.1186/s12882-020-02059-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 09/07/2020] [Indexed: 02/08/2023] Open
Abstract
Background We aimed to examine the risk factors for chronic kidney disease (CKD) stage 3 among adults with ASK from unilateral nephrectomy. Methods We retrospectively collected data from adult patients with ASK between January, 2009 and January, 2019, identified from a tertiary hospital in China. The clinical data were compared between patients who developed CKD stage 3 and those who did not develop CKD stage 3 during follow-up. Results In total, 172 patients with ASK (110 men; median 58.0 years) were enrolled, with a median follow-up duration of 5.0 years. During follow-up, 91 (52.9%) and 24 (14.0%) patients developed CKD stage 3 and end-stage renal disease, respectively. Multiple regression analyses showed that age (odds ratio [OR] 1.076, 95% confidence interval [CI] 1.039–1.115, p < 0.001), diabetes (OR 4.401, 95% CI 1.693–11.44, p = 0.002), hyperuricemia (OR 2.733, 95% CI 1.104–6.764, p = 0.03), a history of cardiovascular disease (CVD) (OR 5.583, 95% CI 1.884–18.068, p = 0.002), and ASK due to renal tuberculosis (OR 8.816, 95% CI 2.92–26.62, p < 0.001) were independent risk factors for developing CKD stage 3 among patients with ASK. Conclusions Regular follow-up of renal function is needed among adult patients with ASK. Optimal management of diabetes, hyperuricemia, and CVD may reduce their risk of CKD stage 3, especially among those that undergo unilateral nephrectomy for renal tuberculosis.
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Affiliation(s)
- Wen-Jun Zhang
- Department of Nephrology, Lan Zhou University Second Hospital, Lanzhou, 730030, China
| | - Zi-Yi Wang
- Department of Nephrology, GanSu University of Chinese Medicine, Lanzhou, 730030, China
| | - Wei-Xing Zhou
- Department of Nephrology, Lan Zhou University Second Hospital, Lanzhou, 730030, China
| | - Ning-Qiang Yang
- Department of Urology Surgery, Lan Zhou University Second Hospital, 82 Cui Ying Gate, Lanzhou, 730030, China
| | - Ya Wang
- Department of Nephrology, Lan Zhou University Second Hospital, Lanzhou, 730030, China
| | - Ya Tang
- Department of Nephrology, Lan Zhou University Second Hospital, Lanzhou, 730030, China
| | - Xiao-Chun Zhou
- Department of Nephrology, Lan Zhou University Second Hospital, Lanzhou, 730030, China
| | - Jie-Cao Dao
- Department of Nephrology, Lan Zhou University Second Hospital, Lanzhou, 730030, China
| | - Yan-Ru Ma
- Department of Nephrology, Lan Zhou University Second Hospital, Lanzhou, 730030, China
| | - Yan-Ping He
- Department of Nephrology, Lan Zhou University Second Hospital, Lanzhou, 730030, China
| | - Xiao-Ling Wang
- Department of Nephrology, Lan Zhou University Second Hospital, Lanzhou, 730030, China
| | - Wen-Ge Wang
- Department of Nephrology, Lan Zhou University Second Hospital, Lanzhou, 730030, China
| | - Li Yang
- Department of Urology Surgery, Lan Zhou University Second Hospital, 82 Cui Ying Gate, Lanzhou, 730030, China.
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Price AM, Greenhall GHB, Moody WE, Steeds RP, Mark PB, Edwards NC, Hayer MK, Pickup LC, Radhakrishnan A, Law JP, Banerjee D, Campbell T, Tomson CRV, Cockcroft JR, Shrestha B, Wilkinson IB, Tomlinson LA, Ferro CJ, Townend JN. Changes in Blood Pressure and Arterial Hemodynamics following Living Kidney Donation. Clin J Am Soc Nephrol 2020; 15:1330-1339. [PMID: 32843374 PMCID: PMC7480552 DOI: 10.2215/cjn.15651219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/19/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The Effect of a Reduction in GFR after Nephrectomy on Arterial Stiffness and Central Hemodynamics (EARNEST) study was a multicenter, prospective, controlled study designed to investigate the associations of an isolated reduction in kidney function on BP and arterial hemodynamics. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Prospective living kidney donors and healthy controls who fulfilled criteria for donation were recruited from centers with expertise in vascular research. Participants underwent office and ambulatory BP measurement, assessment of arterial stiffness, and biochemical tests at baseline and 12 months. RESULTS A total of 469 participants were recruited, and 306 (168 donors and 138 controls) were followed up at 12 months. In the donor group, mean eGFR was 27 ml/min per 1.73 m2 lower than baseline at 12 months. Compared with baseline, at 12 months the mean within-group difference in ambulatory day systolic BP in donors was 0.1 mm Hg (95% confidence interval, -1.7 to 1.9) and 0.6 mm Hg (95% confidence interval, -0.7 to 2.0) in controls. The between-group difference was -0.5 mm Hg (95% confidence interval, -2.8 to 1.7; P=0.62). The mean within-group difference in pulse wave velocity in donors was 0.3 m/s (95% confidence interval, 0.1 to 0.4) and 0.2 m/s (95% confidence interval, -0.0 to 0.4) in controls. The between-group difference was 0.1 m/s (95% confidence interval, -0.2 to 0.3; P=0.49). CONCLUSIONS Changes in ambulatory peripheral BP and pulse wave velocity in kidney donors at 12 months after nephrectomy were small and not different from controls. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER NCT01769924 (https://clinicaltrials.gov/ct2/show/NCT01769924).
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Affiliation(s)
- Anna M Price
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom .,Department of Nephrology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | | | - William E Moody
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Cardiology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Richard P Steeds
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Cardiology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Patrick B Mark
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Nicola C Edwards
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Manvir K Hayer
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Nephrology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Luke C Pickup
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Cardiology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Ashwin Radhakrishnan
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Cardiology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Jonathan P Law
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Nephrology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | | | | | - John R Cockcroft
- Department of Cardiology, Wales Heart Research Institute, University Hospital, Cardiff, United Kingdom
| | - Badri Shrestha
- Sheffield Kidney Institute, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Ian B Wilkinson
- Cambridge Clinical Trials Unit, Clinical School, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | | | - Charles J Ferro
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Nephrology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Jonathan N Townend
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Cardiology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
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Kim JY, Kim DH, Kim YJ, Choi JY, Kwon H, Ko Y, Jung JH, Baek CH, Kim H, Park SK, Kim SB, Lee SK, Lee Y, Kim YH, Han DJ, Shin S. Long-Term Outcome of Live Kidney Donation in South Korea. Ann Transplant 2020; 25:e923065. [PMID: 32792472 PMCID: PMC7448690 DOI: 10.12659/aot.923065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Kidney donors may be at increased risk for end-stage renal disease (ESRD) as well as cardiovascular and all-cause mortality. In particular, data on long-term safety after kidney donation in Asian populations are lacking. We aimed to assess the safety of live kidney donation in Korean donors by using a matched control group. Material/Methods We conducted a retrospective cohort study using a hospital-based database (Asan Medical Center, Seoul, Korea) and a control group from the national health insurance claims database in South Korea. We analyzed the health status of 1608 kidney donors who underwent donation between September 1990 and December 2015, and we compared their characteristics with those of matched 6426 non-donors (1: 4 ratio). We also measured the glomerular filtration rate (GFR) with 51Cr EDTA and urinary albumin excretion and assessed the prevalence of hypertension, diabetes, and general health status in 200 volunteer donors. Results Mortality was significantly lower in kidney donors compared with the matched controls (130.2 vs. 185.4 per 100,000 person-years, P=0.02). There was no significant difference in mortality if a donor had hypertension or was a current smoker at the time of donation. There was also no significant difference in ESRD (43.1 vs. 35.2 per 100,000 person-years, P=0.07) between the 2 groups regardless of hypertension and smoking status. Among the 200 donors with measured GFR, 11.5% had GFR values <60 ml/min/1.73 m2 at 9.4±5.3 years after donation. Older age (P=0.001) and female sex (P=0.021) were significantly associated with GFR values <60 mL/min/1.73 m2. Conclusions Mortality and ESRD were uncommon in carefully selected kidney donors. However, donors with pre-existing risk factors should be followed up more closely to ensure long-term safety.
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Affiliation(s)
- Jee Yeon Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Hyun Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea
| | - Ji Yoon Choi
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunwook Kwon
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Youngmin Ko
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joo Hee Jung
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chung Hee Baek
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyosang Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Su-Kil Park
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soon Bae Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang Koo Lee
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yura Lee
- Department of Biomedical Informatics, Asan Medical Center, Seoul, South Korea
| | - Young Hoon Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duck Jong Han
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Shin
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Park J, Kim M, Park YH, Park M, Shim JW, Lee HM, Kim YS, Moon YE, Hong SH, Chae MS. Delayed remnant kidney function recovery is less observed in living donors who receive an analgesic, intrathecal morphine block in laparoscopic nephrectomy for kidney transplantation: a propensity score-matched analysis. BMC Anesthesiol 2020; 20:165. [PMID: 32631264 PMCID: PMC7336465 DOI: 10.1186/s12871-020-01081-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study analyzed remnant kidney function recovery in living donors after laparoscopic nephrectomy to establish a risk stratification model for delayed recovery and further investigated clinically modifiable factors. PATIENTS AND METHODS This retrospective study included 366 adult living donors who underwent elective donation surgery between January 2017 and November 2019 at our hospital. ITMB was included as an analgesic component in the living donor strategy for early postoperative pain relief from November 2018 to November 2019 (n = 116). Kidney function was quantified based on the estimated glomerular filtration rate (eGFR), and delayed functional recovery of remnant kidney was defined as eGFR < 60 mL/min/1.73 m2 on postoperative day (POD) 1 (n = 240). RESULTS Multivariable analyses revealed that lower risk for development of eGFR < 60 mL/min/1.73 m2 on POD 1 was associated with ITMB, female sex, younger age, and higher amount of hourly fluid infusion (area under the receiver operating characteristic curve = 0.783; 95% confidence interval = 0.734-0.832; p < 0.001). Propensity score (PS)-matching analyses showed that prevalence rates of eGFR < 60 mL/min/1.73 m2 on PODs 1 and 7 were higher in the non-ITMB group than in the ITMB group. ITMB adjusted for PS was significantly associated with lower risk for development of eGFR < 60 mL/min/1.73 m2 on POD 1 in PS-matched living donors. No living donors exhibited severe remnant kidney dysfunction and/or required renal replacement therapy at POD 7. CONCLUSIONS We found an association between the analgesic impact of ITMB and better functional recovery of remnant kidney in living kidney donors. In addition, we propose a stratification model that predicts delayed functional recovery of remnant kidney in living donors: male sex, older age, non-ITMB, and lower hourly fluid infusion rate.
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Affiliation(s)
- Jaesik Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Minju Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong Hyun Park
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Misun Park
- Department of Biostatistics, Clinical Research Coordinating Center, Catholic Medical Center, The Catholic University of Korea, Seoul, South Korea
| | - Jung-Woo Shim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hyung Mook Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong-Suk Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Young Eun Moon
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Nunes-Carneiro D, Madanelo M, Silva F, Pestana N, Ribeiro C, Gil-Sousa D, Martins LS, Almeida M, Dias L, Malheiro J, Cavadas V, Castro-Henriques A, Fraga A, Silva-Ramos M. Remaining kidney volume indexed to weight as a strong predictor of estimated glomerular filtration rate at 1 year and mid-term renal function after living-donor nephrectomy - a retrospective observational study. Transpl Int 2020; 33:1262-1273. [PMID: 32608073 DOI: 10.1111/tri.13683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 01/10/2023]
Abstract
The donors' estimated glomerular filtration rate (eGFR) after living nephrectomy has been a concern, particularly in donors with smaller kindeys. Therefore, we developed this retrospective observational study in 195 donors to determine the ability remaining kidney volume indexed to weight (RKV/W) to predict eGFR at 1 year through multivariate linear regression and to explore this relationship between annual eGFR change from 1 to 4 years postdonation evaluated by a linear mixed model. Comparing RKV/W tertiles (T1, T2, T3), RKV/W was a good predictor of 1-year eGFR which was significantly better in T3 donors. Gender, predonation eGFR, and RKV/W were independent predictors of eGFR at 1-year. In a subgroup with predonation eGFR < 90mL/min/1.73 m2 , a significant prediction of eGFR < 60mL/min/1.73 m2 was detected in males with RKV/W ≤ 2.51cm3 /kg. Annual eGFR (ml/min/year) change from 1 to 4 years was + 0.77. RKV/W divided by tertiles (T1-T3) was the only significant predictor: T2 and T3 donors had an annual eGFR improvement opposing to T1. RKV/W was a good predictor of eGFR at 1 year, independently from predonation eGFR. A higher RKV/W was associated with improved eGFR at 1 year. A decline in eGFR on the four years after surgery was only noticeable in donors with RKV/W ≤ 2.13cm3 /kg.
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Affiliation(s)
- Diogo Nunes-Carneiro
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,i3S/INEB, Universidade do Porto, Porto, Portugal
| | - Mariana Madanelo
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Filipa Silva
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Nicole Pestana
- Nephrology Department, Hospital Dr, Nelio Mendonça Funchal, Porto, Portugal
| | - Catarina Ribeiro
- Nephrology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Diogo Gil-Sousa
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - La Salete Martins
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Manuela Almeida
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Leonídio Dias
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Jorge Malheiro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Vítor Cavadas
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Antonio Castro-Henriques
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Avelino Fraga
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,i3S/INEB, Universidade do Porto, Porto, Portugal
| | - Miguel Silva-Ramos
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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122
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Gaillard F. Benefits of Kidney Transplantation or Living Donation? Transplant Direct 2020; 6:e567. [PMID: 32766422 PMCID: PMC7339296 DOI: 10.1097/txd.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- François Gaillard
- AP-HP, Hopital Bichat, Service de néphrologie, Université de Paris, France
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123
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Penno G, Orsi E, Solini A, Bonora E, Fondelli C, Trevisan R, Vedovato M, Cavalot F, Gruden G, Laviola L, Nicolucci A, Pugliese G. Renal hyperfiltration is independently associated with increased all-cause mortality in individuals with type 2 diabetes: a prospective cohort study. BMJ Open Diabetes Res Care 2020; 8:8/1/e001481. [PMID: 32665314 PMCID: PMC7365485 DOI: 10.1136/bmjdrc-2020-001481] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/28/2020] [Accepted: 06/12/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION In addition to favoring renal disease progression, renal 'hyperfiltration' has been associated with an increased risk of death, though it is unclear whether and how excess mortality is related to increased renal function. We investigated whether renal hyperfiltration is an independent predictor of death in patients with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events Italian multicenter study. RESEARCH DESIGN AND METHODS This observational, prospective cohort study enrolled 15 773 patients with type 2 diabetes consecutively attending 19 Italian diabetes clinics in 2006-2008. Serum creatinine, albuminuria, cardiovascular risk factors, and complications/comorbidities were assessed at baseline. Vital status on 31 October 2015 was retrieved for 15 656 patients (99.26%). Patients were stratified (A) by absolute estimated glomerular filtration rate (eGFR) values in eGFR deciles or Kidney Disease: Improving Global Outcomes (KDIGO) categories and (B) based on age-corrected thresholds or age and gender-specific 95th and 5th percentiles in hyperfiltration, hypofiltration, and normofiltration groups. RESULTS The highest eGFR decile/category and the hyperfiltration group included (partly) different individuals with similar clinical features. Age and gender-adjusted death rates were significantly higher in deciles 1, 9, and 10 (≥103.9, 50.9-62.7, and <50.9 mL/min/1.73 m2, respectively) versus the reference decile 3 (92.9-97.5 mL/min/1.73 m2). Mortality risk, adjusted for multiple confounders, was also increased in deciles 1 (HR 1.461 (95% CI 1.175 to 1.818), p=0.001), 9 (1.312 (95% CI 1.107 to 1.555), p=0.002), and 10 (1.976 (95% CI 1.673 to 2.333), p<0.0001) versus decile 3. Similar results were obtained by stratifying patients by KDIGO categories. Death rates and adjusted mortality risks were significantly higher in hyperfiltering and particularly hypofiltering versus normofiltering individuals. CONCLUSIONS In type 2 diabetes, both high-normal eGFR and hyperfiltration are associated with an increased risk of death from any cause, independent of confounders that may directly impact on mortality and/or affect GFR estimation. Further studies are required to clarify the nature of this relationship. TRIAL REGISTRATION NUMBER NCT00715481.
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Affiliation(s)
- Giuseppe Penno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Emanuela Orsi
- Diabetes Service, Endocrinology Unit, IRCCS "Cà Granda - Ospedale Maggiore Policlinico" Foundation, Milan, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | | | - Roberto Trevisan
- Endocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Vedovato
- Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy
| | - Franco Cavalot
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Gabriella Gruden
- Department of Internal Medicine, University of Turin, Turin, Italy
| | - Luigi Laviola
- Department of Emergency and Transplants, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Nicolucci
- Centre for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
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Bailey PK, Wong K, Robb M, Burnapp L, Rogers A, Courtney A, Wroe C. Has the UK living kidney donor population changed over time? A cross-sectional descriptive analysis of the UK living donor registry between 2006 and 2017. BMJ Open 2020; 10:e033906. [PMID: 32546487 PMCID: PMC7299046 DOI: 10.1136/bmjopen-2019-033906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A living-donor kidney transplant is the best treatment for most people with kidney failure. Population cohort studies have shown that lifetime living kidney donor risk is modified by sex, age, ethnicity, body mass index (BMI), comorbidity and relationship to the recipient. OBJECTIVES We investigated whether the UK population of living kidney donors has changed over time, investigating changes in donor demographics. DESIGN We undertook a cross-sectional analysis of the UK living kidney donor registry between January 2006 to December 2017. Data were available on living donor sex, age, ethnicity, BMI, hypertension and relationship to recipient. SETTING UK living donor registry. PARTICIPANTS 11 651 consecutive living kidney donors from January 2006 to December 2017. OUTCOME MEASURES Living kidney donor demographic characteristics (sex, age, ethnicity, BMI and relationship to the transplant recipient) were compared across years of donation activity. Donor characteristics were also compared across different ethnic groups. RESULTS Over the study period, the mean age of donors increased (from 45.8 to 48.7 years, p<0.001), but this change appears to have been limited to the White population of donors. Black donors were younger than White donors, and a greater proportion were siblings of their intended recipient and male. The proportion of non-genetically related non-partner donations increased over the 12-year period of analysis (p value for linear trend=0.002). CONCLUSIONS The increasing age of white living kidney donors in the UK has implications for recipient and donor outcomes. Despite an increase in the number of black, Asian and minority ethnic individuals waitlisted for a kidney transplant, there has been no increase in the ethnic diversity of UK living kidney donors. Black donors in the UK may be at a much greater risk of developing kidney failure due to accumulated risks: whether these risks are being communicated needs to be investigated.
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Affiliation(s)
- Phillippa K Bailey
- Population Health Sciences, Bristol Medical School, Bristol, UK
- Renal Department, North Bristol NHS Trust, Bristol, UK
| | - Katie Wong
- Population Health Sciences, Bristol Medical School, Bristol, UK
- Renal Department, North Bristol NHS Trust, Bristol, UK
| | - Matthew Robb
- Statistics and Clinical Studies Department, NHS Blood and Transplant, Bristol, UK
| | - Lisa Burnapp
- NHS Blood and Transplant Clinical Lead for Living Donation, Renal Department, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Alistair Rogers
- Urology Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Aisling Courtney
- Renal Department, Belfast Health and Social Care Trust, Belfast, UK
| | - Caroline Wroe
- Renal Department, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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Lam NN, Dipchand C, Fortin MC, Foster BJ, Ghanekar A, Houde I, Kiberd B, Klarenbach S, Knoll GA, Landsberg D, Luke PP, Mainra R, Singh SK, Storsley L, Gill J. Canadian Society of Transplantation and Canadian Society of Nephrology Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Can J Kidney Health Dis 2020; 7:2054358120918457. [PMID: 32577294 PMCID: PMC7288834 DOI: 10.1177/2054358120918457] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose of review: To review an international guideline on the evaluation and care of living
kidney donors and provide a commentary on the applicability of the
recommendations to the Canadian donor population. Sources of information: We reviewed the 2017 Kidney Disease: Improving Global Outcomes (KDIGO)
Clinical Practice Guideline on the Evaluation and Care of Living Kidney
Donors and compared this guideline to the Canadian 2014 Kidney Paired
Donation (KPD) Protocol for Participating Donors. Methods: A working group was formed consisting of members from the Canadian Society of
Transplantation and the Canadian Society of Nephrology. Members were
selected to have representation from across Canada and in various
subspecialties related to living kidney donation, including nephrology,
surgery, transplantation, pediatrics, and ethics. Key findings: Many of the KDIGO Guideline recommendations align with the KPD Protocol
recommendations. Canadian researchers have contributed to much of the
evidence on donor evaluation and outcomes used to support the KDIGO
Guideline recommendations. Limitations: Certain outcomes and risk assessment tools have yet to be validated in the
Canadian donor population. Implications: Living kidney donors should be counseled on the risks of postdonation
outcomes given recent evidence, understanding the limitations of the
literature with respect to its generalizability to the Canadian donor
population.
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Affiliation(s)
- Ngan N Lam
- Division of Nephrology, University of Calgary, AB, Canada
| | | | | | - Bethany J Foster
- Division of Pediatric Nephrology, McGill University, Montréal, QC, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, ON, Canada
| | - Isabelle Houde
- Division of Nephrology, Centre Hospitalier de l'Université de Québec, Québec City, Canada
| | - Bryce Kiberd
- Division of Nephrology, Dalhousie University, Halifax, NS, Canada
| | | | - Greg A Knoll
- Division of Nephrology, University of Ottawa, ON, Canada
| | - David Landsberg
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Patrick P Luke
- Division of Urology, Western University, London, ON, Canada
| | - Rahul Mainra
- Division of Nephrology, University of Saskatchewan, Saskatoon, Canada
| | - Sunita K Singh
- Division of Nephrology, University of Toronto, ON, Canada
| | - Leroy Storsley
- Section of Nephrology, University of Manitoba, Winnipeg, Canada
| | - Jagbir Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada
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Wilson GJ, Wood S, Patel C, Oliver K, John G, Ranganathan D, Mallett A, Isbel N. DNAJB11-Related Atypical ADPKD in a Kidney Transplant Donor. Kidney Int Rep 2020; 5:1363-1366. [PMID: 32775842 PMCID: PMC7403562 DOI: 10.1016/j.ekir.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Gregory J Wilson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Simon Wood
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
| | - Chirag Patel
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Kimberley Oliver
- Pathology Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - George John
- Department of Renal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Dwarakanathan Ranganathan
- Department of Renal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Medicine, Griffith University, Brisbane, Australia
| | - Andrew Mallett
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Renal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Nicole Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Melkonian V, Nguyen MTJP. Managing the Obese Living Kidney Donor. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00279-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Long-term prognosis after kidney donation: a propensity score matched comparison of living donors and non-donors from two population cohorts. Eur J Epidemiol 2020; 35:699-707. [PMID: 32440788 PMCID: PMC7387377 DOI: 10.1007/s10654-020-00647-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/06/2020] [Indexed: 01/22/2023]
Abstract
Background Live donor nephrectomy is a safe procedure. However, long-term donor prognosis is debated, necessitating high-quality studies. Methods A follow-up study of 761 living kidney donors was conducted, who visited the outpatient clinic and were propensity score matched and compared to 1522 non-donors from population-based cohort studies. Primary outcome was kidney function. Secondary outcomes were BMI (kg/m2), incidences of hypertension, diabetes, cardiovascular events, cardiovascular and overall mortality, and quality of life. Results Median follow-up after donation was 8.0 years. Donors had an increase in serum creatinine of 26 μmol/l (95% CI 24–28), a decrease in eGFR of 27 ml/min/1.73 m2 (95% CI − 29 to − 26), and an eGFR decline of 32% (95% CI 30–33) as compared to non-donors. There was no difference in outcomes between the groups for ESRD, microalbuminuria, BMI, incidence of diabetes or cardiovascular events, and mortality. A lower risk of new-onset hypertension (OR 0.45, 95% CI 0.33–0.62) was found among donors. The EQ-5D health-related scores were higher among donors, whereas the SF-12 physical and mental component scores were lower. Conclusion Loss of kidney mass after live donation does not translate into negative long-term outcomes in terms of morbidity and mortality compared to non-donors. Trial registration Dutch Trial Register NTR3795. Electronic supplementary material The online version of this article (10.1007/s10654-020-00647-y) contains supplementary material, which is available to authorized users.
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Lam NN, Lloyd A, Lentine KL, Quinn RR, Ravani P, Hemmelgarn BR, Klarenbach S, Garg AX. Changes in kidney function follow living donor nephrectomy. Kidney Int 2020; 98:176-186. [PMID: 32571482 DOI: 10.1016/j.kint.2020.03.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/10/2020] [Accepted: 03/13/2020] [Indexed: 01/28/2023]
Abstract
Better understanding of kidney function after living donor nephrectomy and how it differs by donor characteristics can inform patient selection, counselling, and follow-up care. To evaluate this, we conducted a retrospective matched cohort study of living kidney donors in Alberta, Canada between 2002-2016, using linked healthcare administrative databases. We matched 604 donors to 2,414 healthy non-donors from the general population based on age, sex, year of cohort entry, urban residence and the estimated glomerular filtration rate (eGFR) before cohort entry (nephrectomy date for donors and randomly assigned date for non-donors). The primary outcome was the rate of eGFR change over time (median follow-up seven years; maximum 15 years). The median age of the cohort was 43 years, 64% women, and the baseline (pre-donation) eGFR was 100 mL/min/1.73 m2. Overall, from six weeks onwards, the eGFR increased by +0.35 mL/min/1.73 m2 per year (95% confidence interval +0.21 to +0.48) in donors and significantly decreased by -0.85 mL/min/1.73 m2 per year (-0.94 to -0.75) in the matched healthy non-donors. The change in eGFR between six weeks to two years, two to five years, and over five years among donors was +1.06, +0.64, and -0.06 mL/min/1.73 m2 per year, respectively. In contrast to the steady age-related decline in kidney function in non-donors, post-donation kidney function on average initially increased by 1 mL/min/1.73 m2 per year attributable to glomerular hyperfiltration, which began to plateau by five years post-donation. Thus, the average change in eGFR over time is significantly different between donors and non-donors.
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Affiliation(s)
- Ngan N Lam
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Anita Lloyd
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Krista L Lentine
- Department of Medicine, Center for Abdominal Transplantation, Saint Louis University, St. Louis, Missouri, USA
| | - Robert R Quinn
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Pietro Ravani
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Amit X Garg
- Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
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130
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Rehse G, Halleck F, Khadzhynov D, Lehner LJ, Kleinsteuber A, Staeck A, Duerr M, Budde K, Staeck O. Validation of the Living Kidney Donor Profile Index in a European cohort and comparison of long-term outcomes with US results. Nephrol Dial Transplant 2020; 34:1063-1070. [PMID: 29746671 DOI: 10.1093/ndt/gfy118] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recently, a risk index for living donor kidney (LDK) transplantation [living kidney donor profile index (LKDPI)] was proposed to compare LDKs with each other and with deceased donor kidneys (DDKs). Until now, the LKDPI has not been validated externally. METHODS This long-term retrospective analysis included 1305 consecutive adult kidney transplant recipients who were transplanted 2000-16 in our centre. The Kidney Donor Profile Index (KDPI) was calculated in 889 DDKs and the LKDPI in 416 LDKs. Outcome was followed over a median of 6.5 years. RESULTS The median LKDPI was 17 and the median KDPI was 69, with a high proportion of donor kidneys with a very high KDPI (40% KDPI ≥ 80). Categorization of LDK into LKDPI quartiles (LKDPI -45-3, 3-17, 17-33, 33-90) revealed a significant difference in death-censored graft survival. Comparing corresponding subgroups of the LKDPI and KDPI (LKDPI/KDPI 0-20 or 20-40) showed comparable graft survival. A multivariate analysis adjusting for relevant recipient factors revealed the KDPI [hazard ratio (HR) 1.21; P < 0.001) and LKDPI (HR 1.15; P = 0.049) as significant independent predictors of graft loss. Time-to-event receiver operating characteristic analyses for graft survival demonstrated lower predictive discrimination of the LKDPI [area under the curve (AUC) 0.55] compared with the KDPI (AUC 0.66). The 10-year graft survival of LDK recipients was inferior in the USA compared with our centre (79% versus 84%). CONCLUSIONS These results provide external validation of the LKDPI to predict death-censored graft survival and confirm comparability of the LKDPI with the KDPI to discriminate post-transplant outcome.
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Affiliation(s)
- Gregor Rehse
- Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Halleck
- Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dmytro Khadzhynov
- Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lukas J Lehner
- Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Kleinsteuber
- Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Staeck
- Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Duerr
- Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Klemens Budde
- Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Staeck
- Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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131
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Garg AX, Levey AS, Kasiske BL, Cheung M, Lentine KL. Application of the 2017 KDIGO Guideline for the Evaluation and Care of Living Kidney Donors to Clinical Practice. Clin J Am Soc Nephrol 2020; 15:896-905. [PMID: 32276946 PMCID: PMC7274294 DOI: 10.2215/cjn.12141019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 "Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors" was developed to assist medical professionals who evaluate living kidney donor candidates and provide care before, during, and after donation. This guideline Work Group concluded that a comprehensive approach to donor candidate risk assessment should replace eligibility decisions on the basis of assessments of single risk factors in isolation. To address all issues important to living donors in a pragmatic and comprehensive guideline, many of the guideline recommendations were on the basis of expert consensus opinion even when no direct evidence was available. To advance available evidence, original data analyses were also undertaken to produce a "proof-of-concept" risk projection model for kidney failure. This was done to illustrate how the community can advance a new quantitative framework of risk that considers each candidate's profile of demographic and health characteristics. A public review by stakeholders and subject matter experts as well as industry and professional organizations informed the final formulation of the guideline. This review highlights the guideline framework, key concepts, and recommendations, and uses five patient scenarios and 12 guideline statements to illustrate how the guideline can be applied to support living donor evaluation and care in clinical practice.
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Affiliation(s)
- Amit X Garg
- Division of Nephrology, Western University, London, Ontario, Canada
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Bertram L Kasiske
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes, Brussels, Belgium
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132
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Abstract
Long-term safety of living kidney donation (LKD), especially for young donors, has become a real matter of concern in the transplant community and may contribute to creating resistance to LKD. In this context, the criteria that govern living donor donations must live up to very demanding standards as well as adjust to this novel reality. In the first part, we review the existing guidelines published after 2010 and critically examine their recommendations to see how they do not necessarily lead to consistent and universal practices in the choice of specific thresholds for a parameter used to accept or reject a living donor candidate. In the second part, we present the emergence of a new paradigm for LKD developed in the 2017 Kidney Disease: Improving Global Outcomes guidelines with the introduction of an integrative risk-based approach. Finally, we focus on predonation renal function evaluation, a criteria that remain central in the selection process, and discuss several issues surrounding the donor candidate's glomerular filtration rate assessment.
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133
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Predonation Single Kidney Glomerular Filtration Rate in Living Kidney Transplantation to Predict Graft Function and Donor Functional Gain. Transplant Proc 2020; 52:712-721. [DOI: 10.1016/j.transproceed.2020.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/10/2020] [Indexed: 11/22/2022]
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134
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Massie AB, Holscher CM, Henderson ML, Fahmy LM, Thomas AG, Al Ammary F, Getsin SN, Snyder JJ, Lentine KL, Garg AX, Segev DL. Association of Early Postdonation Renal Function With Subsequent Risk of End-Stage Renal Disease in Living Kidney Donors. JAMA Surg 2020; 155:e195472. [PMID: 31968070 DOI: 10.1001/jamasurg.2019.5472] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Importance Living kidney donation is associated with increased long-term risk of end-stage renal disease (ESRD). An early postdonation marker of ESRD risk could improve postdonation risk assessment and counseling for kidney donors and allow early intervention for donors at increased risk. Objective To determine the association between renal function in the first 6 months postdonation and subsequent risk of ESRD in kidney donors. Design, Setting, and Participants This secondary analysis of a prospective national cohort uses a population-based registry of all living kidney donors in the United States between October 26, 1999, and January 1, 2018, with follow-up through December 31, 2018. All kidney donors who had donated in the date range and had serum creatinine measured at 6 months (±3 months) postdonation were included. Exposures Renal function as measured by estimated glomerular filtration rate 6 months after donation (eGFR6). Main Outcomes and Measures End-stage renal disease, ascertained via linkage to Centers for Medicare & Medicaid Services data. Results A total of 71 468 living kidney donors were included (of 109 065 total donors over this period). Their median (interquartile range) eGFR6 was 63 (54-74) mL/min/1.73 m2. Cumulative incidence of ESRD at 15 years postdonation ranged from 11.7 donors per 10 000 donors with eGFR6 values greater than 70 mL/min/1.73 m2 to 33.1 donors per 10 000 donors with eGFR6 values of 50 mL/min/1.73 m2 or less. Adjusting for age, race, sex, body mass index, and biological relationship, every 10 mL/min/1.73 m2 reduction in eGFR6 was associated with a 28% increased risk of ESRD (adjusted hazard ratio, 1.28 [95% CI, 1.06-1.54]; P = .009). The association between predonation eGFR and ESRD was not significant and was fully mediated by eGFR6 (adjusted hazard ratio, 1.00 [95% CI, 0.86-1.17]; P = .97). The postdonation eGFR value was a better marker of ESRD than eGFR decline after donation or the ratio of eGFR6 to predonation eGFR, as determined by the Akaike information criterion (in which a lower value indicates a better model fit; eGFR6, 1495.61; predonation eGFR - eGFR6, 1503.58; eGFR6 / predonation eGFR, 1502.30). Conclusions and Relevance In this study, there was an independent association of eGFR6 with subsequent ESRD risk in living kidney donors, even after adjusting for predonation characteristics. The findings support measurement of early postdonation serum creatinine monitoring in living kidney donors, and the use of these data to help identify donors who might need more careful surveillance and early intervention.
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Affiliation(s)
- Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lara M Fahmy
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fawaz Al Ammary
- Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samantha N Getsin
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Krista L Lentine
- Center for Abdominal Transplantation, St Louis University, St Louis, Missouri
| | - Amit X Garg
- Department of Medicine, Western University, London, Ontario, Canada
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.,Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
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135
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Schull MJ, Azimaee M, Marra M, Cartagena RG, Vermeulen MJ, Ho M, Guttmann A. ICES: Data, Discovery, Better Health. Int J Popul Data Sci 2020; 4:1135. [PMID: 32935037 PMCID: PMC7477779 DOI: 10.23889/ijpds.v4i2.1135] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
ICES was founded in 1992 to study the health care system and promote effective, efficient and equitable health care. Over 27 years later, the goal remains largely unchanged, though the institute has grown in size and impact. Created as an independent not-for-profit research institute and given what was, at the time, unprecedented access to administrative health data records for the population of Ontario, ICES’ initial focus was to better understand the delivery of hospital services and translate its findings into better health care and policy. From modest beginnings with a handful of researchers located in a few hospital offices, ICES has grown to encompass a community of almost 500 scientists and staff across a network of seven physical sites in Ontario. The original focus on hospital-based services has expanded significantly and now includes research and analysis of community-based health services, health policy, Indigenous health, social determinants of health, and data science.
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Affiliation(s)
- M J Schull
- ICES, 2075 Bayview Avenue, G106, Toronto, ON, Canada (Authors are listed in the order of the sections)
| | - M Azimaee
- ICES, 2075 Bayview Avenue, G106, Toronto, ON, Canada (Authors are listed in the order of the sections)
| | - M Marra
- ICES, 2075 Bayview Avenue, G106, Toronto, ON, Canada (Authors are listed in the order of the sections)
| | - R G Cartagena
- ICES, 2075 Bayview Avenue, G106, Toronto, ON, Canada (Authors are listed in the order of the sections)
| | - M J Vermeulen
- ICES, 2075 Bayview Avenue, G106, Toronto, ON, Canada (Authors are listed in the order of the sections)
| | - M Ho
- ICES, 2075 Bayview Avenue, G106, Toronto, ON, Canada (Authors are listed in the order of the sections)
| | - A Guttmann
- ICES, 2075 Bayview Avenue, G106, Toronto, ON, Canada (Authors are listed in the order of the sections)
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136
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Ghanbariamin R, Chung BW. The effect of the National Kidney Registry on the kidney-exchange market. JOURNAL OF HEALTH ECONOMICS 2020; 70:102301. [PMID: 32032820 DOI: 10.1016/j.jhealeco.2020.102301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 01/10/2020] [Accepted: 01/17/2020] [Indexed: 06/10/2023]
Abstract
We assess the causal effect of the National Kidney Registry (NKR), the largest national kidney-exchange network in the U.S., on kidney-exchange outcomes. Analyzing a unique database hosted by the Scientific Registry of Transplant Recipients (SRTR) that contains information on all kidney donors, wait-listed candidates, and transplant recipients in the U.S., we find that patients in an NKR hospital are 2.5-3 times more likely than their counterparts in a non-NKR hospital to receive a transplant from a living donor, conditional on wait-time. At the same time, NKR participation does not have a significant effect on the desirability of donors and the health status of recipients. We employ various approaches to ensure our finding is robust in addressing the non-random sorting of patients and donors. As far as the outcomes we study, the expansion of the NKR brings about an overall positive impact on the kidney exchange market.
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Affiliation(s)
- Roksana Ghanbariamin
- Analysis Group, 2911 Turtle Creek Blvd, No. 600, Dallas, TX 75219, United States.
| | - Bobby W Chung
- School of Labor and Employment Relations, University of Illinois at Urbana-Champaign, 123 LER building, 504 E. Armory Ave., Champaign, IL 61820, United States.
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137
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Comparison of Medium-term Outcomes of Living Kidney Donors With Longitudinal Healthy Control in the United Kingdom. Transplantation 2020; 104:e65-e74. [DOI: 10.1097/tp.0000000000003082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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138
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Epidemiology research to foster improvement in chronic kidney disease care. Kidney Int 2020; 97:477-486. [DOI: 10.1016/j.kint.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 11/24/2022]
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139
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Wang XD, Liu JP, Fan Y, Song TR, Shi YY, Li YM, Lv YH, Li XH, Huang ZL, Lin T. Individualized Preconditioning for ABO-Incompatible Living-Donor Kidney Transplantation: An Initial Report of 48 Cases from China. Ann Transplant 2020; 25:e920224. [PMID: 32029699 PMCID: PMC7029655 DOI: 10.12659/aot.920224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background ABO-incompatible (ABOi) living-donor kidney transplantation (KTx) is well established in developed countries, but not yet in China. Material/Methods We developed individualized preconditioning protocols for ABOi KTx based on initial ABO antibody titers. After propensity score matching of ABOi with ABO-compatible (ABOc) KTx, post-transplant outcomes were compared. Results Between September 2014 and June 2018, 48 ABOi living-donor KTx candidates received individualized preconditioning, and all underwent subsequent KTx (median initial ABO titers: 16 for IgM and 16 for IgG). Thirty-one recipients (64.6%) were preconditioned with rituximab (median dose: 200 mg, range: 100–500 mg). Among 37 patients (77.1%) who received pre-transplant antibody removal, the median number of sessions of antibody removal required to achieve ABOi KTx was 2 (range: 1–5), which was conducted between days −10 and −1. Eleven ABOi recipients (22.9%) were preconditioned with oral immunosuppressants alone. Hyperacute rejection led to the loss of 2 grafts in the ABOi group. After a median follow-up of 27.6 months (ABOi group) and 29.8 months (ABOc group), there were no significant differences in graft/recipient survival, rejection, and infection. There were marginally higher rates of severe thrombocytopenia (<50×109/L) (P=0.073) and delayed wound healing (P=0.096) in ABOi recipients. Conclusions Our individualized preconditioning protocol evolved as our experience grew, and the short-term clinical outcomes of ABOi KTx did not differ from those of matched ABOc patients. ABOi KTx may be a major step forward in expanding the kidney living-donor pool in China.
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Affiliation(s)
- Xian-Ding Wang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland).,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Jin-Peng Liu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland).,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yu Fan
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland).,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Tu-Run Song
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland).,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yun-Ying Shi
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Ya-Mei Li
- Department of Laboratory Medicine/Research Center of Clinical Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yuan-Hang Lv
- West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Xiao-Hong Li
- Department of Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Zhong-Li Huang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland).,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Tao Lin
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland).,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
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140
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Hamböck M, Staudenherz A, Kainz A, Geist B, Hecking M, Doberer K, Hacker M, Böhmig GA. Determinants of the intercept and slope of glomerular filtration rate in recipients of a live donor kidney transplant. Wien Klin Wochenschr 2020; 133:107-117. [PMID: 32016508 PMCID: PMC7875851 DOI: 10.1007/s00508-020-01610-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/10/2020] [Indexed: 11/18/2022]
Abstract
Background Donor kidney function is considered a critical determinant of allograft survival after live donor (LD) kidney transplantation, but its independent impact on the evolution of graft function is less well defined. The objective of this study was to dissect the relative contribution of LD kidney function to baseline estimated glomerular filtration rate (eGFR) of recipients and its decline. Methods In this study 91 LD kidney transplantations performed between 2007 and 2015 were included. The eGFR of donated kidneys (eGFR-dk) was calculated from total LD eGFR (eGFR-dt) based on the results of isotope nephrography. Recipient eGFR (eGFR-r) determined 6‑monthly until 36 months posttransplantation served as dependent variable in mixed linear models estimating changes in baseline allograft function (intercept) and eGFR‑r slope. Models were adjusted either for eGFR-dk or eGFR-dt, in addition to other potential confounders. Results Overall, unadjusted mean eGFR‑r at baseline (6 months) and its annual decline in allograft function were 56.5 mL/min/1.73 m2 and −0.2 mL/min/1.73 m2, respectively. In multivariate analysis, eGFR-dk impacted on baseline eGFR‑r (0.6 mL/min/1.73 m2 mean estimated increase per unit; P = 0.02) but not on its slope. In the eGFR-dt-adjusted model, a marginal effect was observed for LD age (P = 0.05). Both models identified antibody-mediated rejection (ABMR) as the strongest risk factor of accelerated loss of allograft function (eGFR‑r slope: approximately −6 mL/min/1.73 m2 per year; P ≤ 0.02). Conclusion Donor-related characteristics, most prominently the function of donated kidneys and LD age, were predictive of eGFR at baseline. The ABMR was identified as the cardinal cause of progressive deterioration of allograft function.
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Affiliation(s)
- Martina Hamböck
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Anton Staudenherz
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Department of Nuclear Medicine, Molecular Imaging and Special Endocrinology, University Hospital St. Pölten-Karl Landsteiner University of Health Science, St. Pölten, Austria
| | - Alexander Kainz
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Barbara Geist
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Manfred Hecking
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Konstantin Doberer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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141
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Kasiske BL, Anderson-Haag TL, Duprez DA, Kalil RS, Kimmel PL, Pesavento TE, Snyder JJ, Weir MR. A prospective controlled study of metabolic and physiologic effects of kidney donation suggests that donors retain stable kidney function over the first nine years. Kidney Int 2020; 98:168-175. [PMID: 32331703 DOI: 10.1016/j.kint.2020.01.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/06/2019] [Accepted: 01/03/2020] [Indexed: 12/20/2022]
Abstract
While there have been numerous studies of living kidney donors, most have been retrospective without suitable controls and have yielded conflicting results. To clarify this we studied 205 living donor candidates and 203 controls having no medical conditions precluding donation. Before and at six months, one, two, three, six, and nine years after donation we measured iohexol glomerular filtration rate, clinic blood pressure, urine protein excretion and metabolic parameters reported to be affected by kidney function. We measured 24 hour ambulatory blood pressure at three, six, and nine years and at six and nine years blood pressure after treadmill exercise, carotid-femoral pulse wave velocity and arterial elasticity. Between six months and nine years, the mean (95% confidence interval) change in glomerular filtration rate was significantly different among 133 donors 0·02 (-0·16-0·20) mL/min/1·73m2/year versus -1·26 (-1·52--1·00) mL/min/1·73m2/year in 113 healthy controls. Blood pressure, urine protein, urine albumin, glucose, hemoglobin A1c, insulin, and lipoproteins were not different in controls versus donors; but parathyroid hormone, homocysteine and uric acid remained higher at nine years. At six and nine years carotid-femoral pulse wave velocity was not different, but the mean small artery elasticity was significantly lower in 141 donors 6·1 mL/mmHg x100, versus 113 controls 7·1 mL/mmHg x100, and 6·1 mL/mmHg x100 in 137 donors versus 7·6 mL/mmHg x100 in 112 controls at six and nine years, respectively [significant adjusted difference of 1·1 mL/mmHg x100]. Thus, donors remain healthy with stable kidney function for the first nine years, but differences in metabolic and vascular parameters could be harbingers of adverse outcomes requiring future interventions.
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Affiliation(s)
- Bertram L Kasiske
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
| | | | - Daniel A Duprez
- Department of Medicine, Cardiology Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roberto S Kalil
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Paul L Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Todd E Pesavento
- Division of Nephrology, Ohio State University, Columbus, Ohio, USA
| | - Jon J Snyder
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Matthew R Weir
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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142
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Mandelbrot DA, Reese PP, Garg N, Thomas CP, Rodrigue JR, Schinstock C, Doshi M, Cooper M, Friedewald J, Naik AS, Kaul DR, Ison MG, Rocco MV, Verbesey J, Hladunewich MA, Ibrahim HN, Poggio ED. KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Am J Kidney Dis 2020; 75:299-316. [PMID: 32007233 DOI: 10.1053/j.ajkd.2019.10.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/27/2022]
Abstract
Living kidney donation is widely practiced throughout the world. During the past 2 decades, various groups have provided guidance about the evaluation and care of living donors. However, during this time, our knowledge in the field has advanced substantially and many agreed on the need for a comprehensive, unifying document. KDIGO (Kidney Disease: Improving Global Outcomes) addressed this issue at an international level with the publication of its clinical practice guideline on the evaluation and care of living kidney donors. The KDIGO work group extensively reviewed the available literature and wrote a series of guideline recommendations using various degrees of evidence when available. As has become recent practice, NKF-KDOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) convened a work group to provide a commentary on the KDIGO guideline, with a focus on how these recommendations apply in the context of the United States. In the United States, the United Network for Organ Sharing (UNOS) guides and regulates the practice of living kidney donation. While the KDIGO guideline for the care of living kidney donors and UNOS policy are similar in most aspects of the care of living kidney donors, several important areas are not consistent or do not align with common practice by US transplantation programs in areas in which UNOS has not set specific policy. For the time being, and recognizing the value of the KDIGO guidelines, US transplantation programs should continue to follow UNOS policy.
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Affiliation(s)
| | - Peter P Reese
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Neetika Garg
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | - Carrie Schinstock
- Division of Nephrology and Hypertension, William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Mona Doshi
- Division of Nephrology, University of Michigan, Ann Arbor, MI
| | - Matthew Cooper
- Georgetown University School of Medicine, MedStar Georgetown Transplant Institute, Washington, DC
| | - John Friedewald
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Abhijit S Naik
- Division of Nephrology, University of Michigan, Ann Arbor, MI
| | | | - Michael G Ison
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Jennifer Verbesey
- MedStar Georgetown Transplant Institute and Children's National Health System, Washington, DC
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Nanji Family Kidney Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Emilio D Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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143
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Haller MC, Wallisch C, Mjøen G, Holdaas H, Dunkler D, Heinze G, Oberbauer R. Predicting donor, recipient and graft survival in living donor kidney transplantation to inform pretransplant counselling: the donor and recipient linked iPREDICTLIVING tool - a retrospective study. Transpl Int 2020; 33:729-739. [PMID: 31970822 PMCID: PMC7383676 DOI: 10.1111/tri.13580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/23/2019] [Accepted: 01/17/2020] [Indexed: 01/02/2023]
Abstract
Although separate prediction models for donors and recipients were previously published, we identified a need to predict outcomes of donor/recipient simultaneously, as they are clearly not independent of each other. We used characteristics from transplantations performed at the Oslo University Hospital from 1854 live donors and from 837 recipients of a live donor kidney transplant to derive Cox models for predicting donor mortality up to 20 years, and recipient death, and graft loss up to 10 years. The models were developed using the multivariable fractional polynomials algorithm optimizing Akaike’s information criterion, and optimism‐corrected performance was assessed. Age, year of donation, smoking status, cholesterol and creatinine were selected to predict donor mortality (C‐statistic of 0.81). Linear predictors for donor mortality served as summary of donor prognosis in recipient models. Age, sex, year of transplantation, dialysis vintage, primary renal disease, cerebrovascular disease, peripheral vascular disease and HLA mismatch were selected to predict recipient mortality (C‐statistic of 0.77). Age, dialysis vintage, linear predictor of donor mortality, HLA mismatch, peripheral vascular disease and heart disease were selected to predict graft loss (C‐statistic of 0.66). Our prediction models inform decision‐making at the time of transplant counselling and are implemented as online calculators.
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Affiliation(s)
- Maria C Haller
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria.,Nephrology, Ordensklinikum Linz, Elisabethinen, Linz, Austria
| | - Christine Wallisch
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | - Geir Mjøen
- Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Hallvard Holdaas
- Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Daniela Dunkler
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | - Georg Heinze
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | - Rainer Oberbauer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
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144
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MACROSCOPIC AND MICROSCOPIC CONDITIONS OF THE SINGLE KIDNEY AND URETEROPELVIC JUNCTION AFTER THE CONTRALATERAL NEPHRECTOMY. WORLD OF MEDICINE AND BIOLOGY 2020. [DOI: 10.26724/2079-8334-2020-1-71-201-205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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145
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Affiliation(s)
- Stephen C. Textor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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146
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Srivastava T, Ju W, Milne GL, Rezaiekhaligh MH, Staggs VS, Alon US, Sharma R, Zhou J, El-Meanawy A, McCarthy ET, Savin VJ, Sharma M. Urinary prostaglandin E 2 is a biomarker of early adaptive hyperfiltration in solitary functioning kidney. Prostaglandins Other Lipid Mediat 2019; 146:106403. [PMID: 31838197 DOI: 10.1016/j.prostaglandins.2019.106403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/20/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Hyperfiltration is a major contributor to progression of chronic kidney disease (CKD) in diabetes, obesity and in individuals with solitary functioning kidney (SFK). We have proposed hyperfiltration-induced injury as a continuum of overlapping glomerular changes caused by increased biomechanical forces namely, fluid flow shear stress (FFSS) and tensile stress. We have shown that FFSS is elevated in animals with SFK and, it upregulates prostaglandin E2 (PGE2), cyclooxygenase-2 and PGE2 receptor EP2 in cultured podocytes and in uninephrectomized mice. We conceptualized urinary PGE2 as a biomarker of early effects of hyperfiltration-induced injury preceding microalbuminuria in individuals with SFK. We studied children with SFK to validate our hypothesis. METHODS Urine samples from children with SFK and controls were analyzed for PGE2, albumin (glomerular injury biomarker) and epidermal growth factor (EGF, tubular injury biomarker). Age, gender, and Z-scores for height, weight, BMI, and blood pressure were obtained. RESULTS Children with SFK were comparable to controls except for lower BMI Z-scores. The median values were elevated in SFK compared to control for urine PGE2 [9.1 (n = 57) vs. 5.7 (n = 72), p = 0.009] ng/mgCr and albumin [7.6 (n = 40) vs. 7.0 (n = 41), p = 0.085] μg/mgCr, but not for EGF [20098 (n = 44) vs. 18637 (n = 44), p = 0.746] pg/mgCr. Significant increase in urinary PGE2 (p = 0.024) and albumin (p = 0.019) but not EGF (p = 0.412) was observed using additional regression modeling. These three urinary analytes were independent of each other. CONCLUSION Increased urinary PGE2 from elevated SNGFR and consequently increased FFSS during early stage of CKD precedes overt microalbuminuria and is a biomarker for early hyperfiltration-induced injury in individuals with SFK.
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Affiliation(s)
- Tarak Srivastava
- Division of Nephrology, Children's Mercy Hospital and University of Missouri at Kansas City, Kansas City, MO, United States; Research and Development, Nephrology, Kansas City VA Medical Center, Kansas City, MO, United States.
| | - Wenjun Ju
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ginger L Milne
- Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN, United States
| | - Mohamed H Rezaiekhaligh
- Division of Nephrology, Children's Mercy Hospital and University of Missouri at Kansas City, Kansas City, MO, United States
| | - Vincent S Staggs
- Biostatistics & Epidemiology Core, Children's Mercy Kansas City, Department of Pediatrics, University of Missouri, Kansas City, United States
| | - Uri S Alon
- Division of Nephrology, Children's Mercy Hospital and University of Missouri at Kansas City, Kansas City, MO, United States
| | - Ram Sharma
- Research and Development, Nephrology, Kansas City VA Medical Center, Kansas City, MO, United States
| | - Jianping Zhou
- Research and Development, Nephrology, Kansas City VA Medical Center, Kansas City, MO, United States; Midwest Biomedical Research Foundation (MBRF), KCVA Medical Center, Kansas City, MO, United States
| | - Ashraf El-Meanawy
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ellen T McCarthy
- Kidney Institute, Kansas University Medical Center, Kansas City, KS, United States
| | - Virginia J Savin
- Research and Development, Nephrology, Kansas City VA Medical Center, Kansas City, MO, United States; Kidney Institute, Kansas University Medical Center, Kansas City, KS, United States
| | - Mukut Sharma
- Research and Development, Nephrology, Kansas City VA Medical Center, Kansas City, MO, United States; Midwest Biomedical Research Foundation (MBRF), KCVA Medical Center, Kansas City, MO, United States; Kidney Institute, Kansas University Medical Center, Kansas City, KS, United States
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147
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Nelson RG, Grams ME, Ballew SH, Sang Y, Azizi F, Chadban SJ, Chaker L, Dunning SC, Fox C, Hirakawa Y, Iseki K, Ix J, Jafar TH, Köttgen A, Naimark DMJ, Ohkubo T, Prescott GJ, Rebholz CM, Sabanayagam C, Sairenchi T, Schöttker B, Shibagaki Y, Tonelli M, Zhang L, Gansevoort RT, Matsushita K, Woodward M, Coresh J, Shalev V. Development of Risk Prediction Equations for Incident Chronic Kidney Disease. JAMA 2019; 322:2104-2114. [PMID: 31703124 PMCID: PMC6865298 DOI: 10.1001/jama.2019.17379] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Early identification of individuals at elevated risk of developing chronic kidney disease (CKD) could improve clinical care through enhanced surveillance and better management of underlying health conditions. OBJECTIVE To develop assessment tools to identify individuals at increased risk of CKD, defined by reduced estimated glomerular filtration rate (eGFR). DESIGN, SETTING, AND PARTICIPANTS Individual-level data analysis of 34 multinational cohorts from the CKD Prognosis Consortium including 5 222 711 individuals from 28 countries. Data were collected from April 1970 through January 2017. A 2-stage analysis was performed, with each study first analyzed individually and summarized overall using a weighted average. Because clinical variables were often differentially available by diabetes status, models were developed separately for participants with diabetes and without diabetes. Discrimination and calibration were also tested in 9 external cohorts (n = 2 253 540). EXPOSURES Demographic and clinical factors. MAIN OUTCOMES AND MEASURES Incident eGFR of less than 60 mL/min/1.73 m2. RESULTS Among 4 441 084 participants without diabetes (mean age, 54 years, 38% women), 660 856 incident cases (14.9%) of reduced eGFR occurred during a mean follow-up of 4.2 years. Of 781 627 participants with diabetes (mean age, 62 years, 13% women), 313 646 incident cases (40%) occurred during a mean follow-up of 3.9 years. Equations for the 5-year risk of reduced eGFR included age, sex, race/ethnicity, eGFR, history of cardiovascular disease, ever smoker, hypertension, body mass index, and albuminuria concentration. For participants with diabetes, the models also included diabetes medications, hemoglobin A1c, and the interaction between the 2. The risk equations had a median C statistic for the 5-year predicted probability of 0.845 (interquartile range [IQR], 0.789-0.890) in the cohorts without diabetes and 0.801 (IQR, 0.750-0.819) in the cohorts with diabetes. Calibration analysis showed that 9 of 13 study populations (69%) had a slope of observed to predicted risk between 0.80 and 1.25. Discrimination was similar in 18 study populations in 9 external validation cohorts; calibration showed that 16 of 18 (89%) had a slope of observed to predicted risk between 0.80 and 1.25. CONCLUSIONS AND RELEVANCE Equations for predicting risk of incident chronic kidney disease developed from more than 5 million individuals from 34 multinational cohorts demonstrated high discrimination and variable calibration in diverse populations. Further study is needed to determine whether use of these equations to identify individuals at risk of developing chronic kidney disease will improve clinical care and patient outcomes.
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Affiliation(s)
- Robert G. Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
| | - Morgan E. Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shoshana H. Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- OptumLabs, Cambridge, Massachusetts
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Layal Chaker
- Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Caroline Fox
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- The Framingham Heart Study, Framingham, Massachusetts
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunitoshi Iseki
- Nakamura Clinic & Okinawa Asia Clinical Investigation Synergy, Okinawa, Japan
| | - Joachim Ix
- University of California, San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, San Diego
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore
- Department of Medicine, Aga Khan University, Karachi, Pakistan
- Duke Global Health Institute, Durham, Duke University, North Carolina
| | - Anna Köttgen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | | | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Gordon J. Prescott
- Medical Statistics Team, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Casey M. Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Charumathi Sabanayagam
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University, Tochigi, Japan
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Luxia Zhang
- Peking University Institute of Nephrology, Division of Nephrology, Peking University First Hospital, Beijing, China
| | - Ron T. Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mark Woodward
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- The George Institute for Global Health, University of Oxford, United Kingdom
- The George Institute for Global Health, University of New South Wales, Australia
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Varda Shalev
- Medical Division, Maccabi Healthcare Services, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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148
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Cash E, Graver A, Kuo S, Kirkland G, Hughes P, Robertson A, Jose MD. Why do not all living kidney donor candidates proceed to donation? Intern Med J 2019; 49:384-387. [PMID: 30897662 DOI: 10.1111/imj.14223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/05/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
There are national and international guidelines for donor workup and acceptance criteria of potential living kidney donor candidates (LKDC), but there is significant variation in clinical practice. We examined our local practice in assessing potential LKDC against current guidelines; nearly all of our accepted donors met these guidelines. LKDC who did not proceed to donation had an identified health issue (60%), the presence of risk factors for long-term end-stage kidney disease (17%), social (13%) or immunological reasons (7%).
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Affiliation(s)
- Ellie Cash
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Alison Graver
- Renal Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Stephanie Kuo
- Renal Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | | | - Peter Hughes
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amanda Robertson
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Matthew D Jose
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.,Renal Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia
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149
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Muzaale AD, Massie AB, Al Ammary F, Henderson ML, Purnell TS, Holscher CM, Garonzik-Wang J, Locke JE, Snyder JJ, Lentine KL, Segev DL. Donor-Recipient Relationship and Risk of ESKD in Live Kidney Donors of Varied Racial Groups. Am J Kidney Dis 2019; 75:333-341. [PMID: 31732232 DOI: 10.1053/j.ajkd.2019.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 08/19/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE & OBJECTIVE Risk factors for kidney failure are the basis of live kidney donor candidate evaluation. We quantified risk for end-stage kidney disease (ESKD) by the biological relationship of the donor to the recipient, a risk factor that is not addressed by current clinical practice guidelines. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS A cohort of 143,750 US kidney donors between 1987 and 2017. EXPOSURE Biological relationship of donor and recipient. OUTCOME ESKD. Donors' records were linked to national dialysis and transplantation registries to ascertain development of the outcome. ANALYTIC APPROACH Donors were observed over a median of 12 (interquartile range, 6-18; maximum, 30) years. Survival analysis methods that account for the competing risk for death were used. RESULTS Risk for ESKD varied by orders of magnitude across donor-recipient relationship categories. For Asian donors, risks compared with unrelated donors were 259.4-fold greater for identical twins (95% CI, 19.5-3445.6), 4.7-fold greater for full siblings (95% CI, 0.5-41.0), 3.5-fold greater for offspring (95% CI, 0.6-39.5), 1.0 for parents, and 1.0 for half-sibling or other biological relatives. For black donors, risks were 22.5-fold greater for identical twin donors (95% CI, 4.7-107.0), 4.1-fold for full siblings (95% CI, 2.1-7.8), 2.7-fold for offspring (95% CI, 1.4-5.4), 3.1-fold for parents (95% CI, 1.4-6.8), and 1.3-fold for half-sibling or other biological relatives (95% CI, 0.5-3.3). For white donors, risks were 3.5-fold greater for identical twin donors (95% CI, 0.5-25.3), 2.0-fold for full siblings (95% CI, 1.4-2.8), 1.4-fold for offspring (95% CI, 0.9-2.3), 2.9-fold for parents (95% CI, 2.0-4.1), and 0.8-fold for half-sibling or other biological relatives (95% CI, 0.3-1.6). LIMITATIONS Insufficient sample size in some race and relationship groups. Absence of data for family history of kidney disease for donors biologically unrelated to their recipients. CONCLUSIONS Marked differences in risk for ESKD across types of donor-recipient relationship were observed for Asian, black, and white donors. These findings warrant further validation with more robust data to better inform clinical practice guidelines.
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Affiliation(s)
- Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jayme E Locke
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
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150
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Nishida S, Hidaka Y, Toyoda M, Kinoshita K, Tanaka K, Kawabata C, Hamanoue S, Inadome A, Yokomizo H, Takeda A, Uekihara S, Yamanaga S. Factors related to suboptimal recovery of renal function after living donor nephrectomy: a retrospective study. BMC Nephrol 2019; 20:403. [PMID: 31703636 PMCID: PMC6842234 DOI: 10.1186/s12882-019-1588-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 10/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background The renal function of the remaining kidney in living donors recovers up to 60~70% of pre-donation estimated-glomerular filtration rate (eGFR) by compensatory hypertrophy. However, the degree of this hypertrophy varies from donor to donor and the factors related to it are scarcely known. Methods We analyzed 103 living renal transplantations in our institution and divided them into two groups: compensatory hypertrophy group [optimal group, 1-year eGFR ≥60% of pre-donation, n = 63] and suboptimal compensatory hypertrophy group (suboptimal group, 1-year eGFR < 60% of pre-donation, n = 40). We retrospectively analyzed the factors related to suboptimal compensatory hypertrophy. Results Baseline eGFRs were the same in the two groups (optimal versus suboptimal: 82.0 ± 13.1 ml/min/1.73m2 versus 83.5 ± 14.8 ml/min/1.73m2, p = 0.588). Donor age (optimal versus suboptimal: 56.0 ± 10.4 years old versus 60.7 ± 8.7 years old, p = 0.018) and uric acid (optimal versus suboptimal: 4.8 ± 1.2 mg/dl versus 5.5 ± 1.3 mg/dl, p = 0.007) were significantly higher in the suboptimal group. The rate of pathological chronicity finding on 1-h biopsy (ah≧1 ∩ ct + ci≧1) was much higher in the suboptimal group (optimal versus suboptimal: 6.4% versus 25.0%, p = 0.007). After the multivariate analysis, the pathological chronicity finding [odds ratio (OR): 4.8, 95% confidence interval (CI): 1.3–17.8, p = 0.021] and uric acid (per 1.0 mg/dl, OR: 1.5, 95% CI: 1.1–2.2, p = 0.022) were found to be independent risk factors for suboptimal compensatory hypertrophy. Conclusion Chronicity findings on baseline biopsy and higher uric acid were associated with insufficient recovery of the post-donated renal function.
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Affiliation(s)
- Sho Nishida
- Department of General Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto, 861-8520, Japan.,Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Yuji Hidaka
- Department of General Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Mariko Toyoda
- Department of Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kohei Kinoshita
- Department of General Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Kosuke Tanaka
- Department of General Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Chiaki Kawabata
- Department of Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Satoshi Hamanoue
- Department of Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Akito Inadome
- Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Hiroshi Yokomizo
- Department of General Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Myoken-cho, Japan
| | - Soichi Uekihara
- Department of Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shigeyoshi Yamanaga
- Department of General Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto, 861-8520, Japan.
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