A higher glomerular filtration rate predicts low risk of developing chronic kidney disease in living kidney donors
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Published on: June 30, 2018
Shang-Feng Tsai1, Kuo-Hsiung Shu, Ming-Ju Wu
1Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Section 3, Chung-Kang Road, Taichung, 407, Taiwan. acde0324@vghtc.gov.tw
Insights
Living kidney donors with a lower estimated glomerular filtration rate (eGFR) are at higher risk for chronic kidney disease (CKD). Maintaining an eGFR above 90 ml/min/1.73 m² before donation is crucial for preventing CKD in living kidney donors.
Area of Science:
- Nephrology
- Transplantation Medicine
- Public Health
Background:
- The long-term risk of chronic kidney disease (CKD) in living kidney donors (LKDs) is often overlooked.
- Investigating risk factors and refining estimated glomerular filtration rate (eGFR) criteria are essential for LKD health.
- This study focuses on preventing CKD development in LKDs.
Purpose of the Study:
- To identify risk factors for CKD development in LKDs.
- To evaluate the efficacy of eGFR indexed for body surface area (BSA) in predicting CKD risk.
- To establish new criteria for LKD selection to minimize long-term health risks.
Main Methods:
- Retrospective study of 105 LKDs from May 1983 to March 2011.
- Statistical analysis included Mann-Whitney U test, chi-squared test, and Cox regression.
- Survival analysis focused on CKD-free survival based on eGFR classifications.
Main Results:
- Mean eGFR decreased significantly from 88.9 to 61.4 ml/min/1.73 m² post-donation (p=0.002).
- Median CKD-free survival was 5.7 years.
- Pre-donation eGFR >90 ml/min/1.73 m² was identified as a protective factor against CKD (HR=0.952, p=0.0199).
Conclusions:
- Insufficient pre-donation eGFR is linked to CKD development in LKDs over time.
- An eGFR exceeding 90 ml/min/1.73 m² before donation is key for CKD prevention.
- Further research is needed for LKDs with eGFR between 80-90 ml/min/1.73 m².
Background:
The risk of developing chronic kidney disease (CKD) among living kidney donors (LKDs) is seldom included in evaluations of patients' outcomes. Potential risk factors and new criteria for estimating the glomerular filtration rate (eGFR) indexed for body surface area (BSA) were investigated with a view to prevent the development of CKD in LKDs.
Methods:
We conducted a retrospective study of LKDs from May 1983 to March 2011. The Mann-Whitney U test and χ(2) test were used to analyze the male versus female groups. Survival analysis was plotted as CKD-free survival and analyzed separately by different eGFR index classifications. The Cox regression model was used to identify potential risk factors for development of CKD.
Results:
A total of 105 LKDs with a mean age of 46.3 ± 12.5 years had a mean eGFR indexed for BSA of 88.9 ± 21.5 ml/min per 1.73 m(2). After a mean duration of 5.4 ± 4.9 years' follow-up, eGFR dropped to 61.4 ± 16.4 ml/min per 1.73 m(2) (p = 0.002). Median CKD-free survival was only 5.7 years. The difference between eGFR ≥ 80 ml/min per 1.73 m(2) and <80 ml/min per 1.73 m(2) was not statistically significant (p = 0.980). Multivariate Cox regression analysis showed that higher eGFR at donation (HR = 0.952, p = 0.0199) could be a protective factor. The receiver operating characteristic (ROC) curve for initial eGFR with best sensitivity of 52.78 % and specificity of 81.40 % was obtained with a cutoff value of 90.2 ml/min per 1.73 m(2) for preoperative eGFR. An eGFR of 90 ml/min per 1.73 m(2) yielded a significant survival curve (p = 0.0199) after 21 years of follow-up. Further classifications of eGFR >90 ml/min per 1.73 m(2) into 90-99 ml/min per 1.73 m(2), 100-109 ml/min per 1.73 m(2), and ≥110 ml/min per 1.73 m(2) were examined, but this survival curve was not statistically significant (p = 0.1247).
Conclusions:
Living kidney donors will develop CKD after a long duration of follow-up if there is insufficiently high eGFR at donation. An eGFR above 90 ml/min per 1.73 m(2) before donation is the only factor that predicts prevention of CKD. Larger studies with longer duration of follow-up are necessary to clarify the clinical outcome of this postoperative CKD group, especially for patients with eGFR between 80 and 90 ml/min per 1.73 m(2).
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