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Creatinine-based equations predicting chronic kidney disease after kidney donation
A B Libório1, R M Barros, R M Esmeraldo
1Division of Nephrology, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil.
Insights
Living kidney donors require long-term monitoring for potential complications like hypertension and dyslipidemia. The CKD-EPI equation is recommended for assessing kidney function to predict chronic kidney disease risk.
Area of Science:
- Nephrology
- Transplantation Medicine
- Public Health
Background:
- Living kidney donation is generally safe with minimal adverse outcomes.
- Long-term health outcomes for living kidney donors require ongoing evaluation.
- Assessing the predictive utility of creatinine-based equations for chronic kidney disease (CKD) in donors is crucial.
Purpose of the Study:
- To evaluate the long-term health outcomes of living kidney donors.
- To assess the effectiveness of different creatinine-based equations in predicting CKD in kidney donors.
- To identify potential complications following kidney donation.
Main Methods:
- Retrospective analysis of 154 living kidney donors (2001-2009).
- Demographic data and laboratory evaluations were collected for 78 donors.
- Estimated glomerular filtration rate (GFR) calculated using MDRD, Cockcroft-Gault (C-G), and CKD-EPI equations.
- Receiver operating characteristic (ROC) analysis used to compare equation performance in predicting CKD.
Main Results:
- Median donor age 39 years, 64% female; mean follow-up 65 months.
- Hypertension (20.5%), elevated creatinine (14.1%), and dyslipidemia (33.3%) were observed.
- CKD-EPI and MDRD equations identified significantly more donors with GFR < 60 mL/min compared to C-G (29.4% vs. <1.5%).
- CKD-EPI demonstrated a significant area under the ROC curve (0.7442, P = .003) for predicting renal failure.
Conclusions:
- Living kidney donors necessitate comprehensive long-term follow-up care.
- The CKD-EPI equation is the preferred method for assessing renal function and predicting CKD risk in donors.
- Vigilant management of hypertension and dyslipidemia is essential for living kidney donor health.
Background:
Kidney donation is associated with few adverse outcomes in living donors. The aim of this study was to evaluate the outcomes of living kidney donors and the utility of creatinine-based equations to predict chronic kidney disease.
Methods:
The study population was selected among 154 living kidney donors from 2001 to 2009. Seventy-eight patients underwent medical consultation to review demographic data and perform laboratory evaluations. Estimated glomerular filtration rate (GFR) values were obtained by three equations: Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault (C-G) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Receiver operating characteristic (ROC) analysis was performed to determine the area under the curve of each equation to predict evolution to chronic kidney disease.
Results:
The overall median age was 39 years including 64% of women subjects. The mean follow-up after kidney donation was 65 ± 34 months. During follow-up, 20.5% of patients developed hypertension. Serum creatinine values above 1.5 mg/dL were detected in 14.1% of cases. Dyslipidemia was present in 33.3% of donors at the last follow-up. According to measured creatinine clearance and the C-G equation, only four and six donors had renal failure (defined as GFR < 60 mL/min), a number that increased to 23 (29.4%) when considering the MDRD or CKD-EPI equations (P < .05). ROC curves performed to explore the GFR measurements to predict renal failure occurrence after donation showed the CKD-EPI to be the only one with a significant area under the curve (0.7442, P = .003).
Conclusion:
Living kidney donors should receive careful long-term follow-up. Assessment of renal function before donation using CKD-EPI creatinine-based equations must be performed preferentially. A careful approach should be adopted for the detection and treatment of other complications such as hypertension and dyslipidemia.
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