A prospective study of living kidney donors: 6 years follow-up from a cardiovascular disease risk perspective

Risk factors for lower renal compensation after nephrectomy: an analysis of living kidney donors in an Amazonian cohort

INTRODUCTION

Living donor kidney transplantation is considered the ideal renal replacement therapy because it has a lower complication rate and allows an efficient response to the high demand for grafts in the healthcare system. Careful selection and adequate monitoring of donors is a key element in transplantation. Individuals at greater risk of developing kidney dysfunction after nephrectomy must be identified.

OBJECTIVE

To identify risk factors associated with a renal compensation rate (CR) below 70% 12 months after nephrectomy.

METHODS

This observational retrospective longitudinal study included living kidney donors followed up at the Lower Amazon Regional Hospital between 2016 and 2022. Data related to sociodemographic variables, comorbid conditions and kidney function parameters were collected.

RESULTS

The study enrolled 32 patients. Fourteen (43.75%) had a CR < 70% 12 months after kidney donation. Logistic regression found obesity (Odds Ratio [95%CI]: 10.6 [1.7-65.2]), albuminuria (Odds Ratio [95%CI]: 2.41 [1.2-4.84]) and proteinuria (Odds Ratio [95%CI]: 1.14 [1.03-1.25]) as risk factors. Glomerular filtration rate was a protective factor (Odds Ratio [95% CI]: 0.92 [0.85-0.99]).

CONCLUSION

Obesity, albuminuria and proteinuria adversely affected short-term renal compensation rate. Further studies are needed to uncover the prognostic implications tied to these risk factors. Our findings also supported the need for careful individualized assessment of potential donors and closer monitoring of individuals at higher risk.

Donor Evaluation of Living Kidney Transplantation in the Aging Society

BACKGROUND

Because of the lack of organ donation, living kidney transplantation (LKT) is increasing worldwide. Recently, the number of elderly donors has been increasing, and the patients with end-stage kidney diseases are older than those in the previous decades. Due to the advanced ages, their glomerular filtration rates (GFR) decrease, and the comorbidities such as hypertension, diabetic condition, and obesity are common. The clinicians now have to give their unwilling consent to the LKT from the donors with expanded criteria.

SUMMARY

For the secure selection of donors, proper GFR measuring is essential. Although directly measured GFR (mGFR) was recommended in the guidelines, estimated GFR (eGFR) is used at the initial evaluation of donor renal function clinically. Many equations calculating eGFR have been published so far. In the selection of eGFR equations, the smaller difference between mGFR and eGFR and the closer relationship to the prevalence rates of comorbidities are requisite points. Therefore, we compared the specificity of the various eGFR equations. The eGFR calculated from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation showed approximate reliability with minimal difference between mGFR and eGFR and the closer relationships to the prevalence rates of comorbidities.

KEY MESSAGE

The CKD-EPI-eGFR presented optimal performance in the donor renal function evaluation. Therefore, eGFR from the CKD-EPI equation is highly recommended in evaluating renal function in LKT donors.