Prediabetic living kidney donors have preserved kidney function at 10 years after donation

Potential living kidney donors with prediabetes are often excluded from donation because of concerns about the development of type 2 diabetes mellitus (DM) and progression to end-stage renal disease (ESRD). This strategy may be unnecessarily restrictive. Previous studies of living kidney donors have not specifically examined subsets with prediabetes.

We ascertained the vital status and development of ESRD in 143 living kidney donors from 1994 to 2007 with predonation impaired fasting glucose (IFG). We then compared the development of DM, the estimated glomerular filtration rate, and the level of albumin excretion in 45 of these IFG donors to 45 matched controls with normal predonation fasting glucose.

The majority (57.8%) of IFG donors had reverted to normal fasting glucose at a mean follow-up of 10.4 years. Compared with donors with normal fasting glucose, a higher proportion of IFG donors had developed DM (15.56% vs. 2.2%, P=0.06). Predonation characteristics including age, sex, and body mass index did not correlate with the risk of developing DM. At follow- up, estimated glomerular filtration rate by the Modification of Diet in Renal Disease equation (70.7±16.1 mL/min/1.73 m vs. 67.3±16.6 mL/min/1.73 m, P=0.21) and albumin excretion (urine albumin/ creatinine 9.76±23.6 mg/g vs. 5.91±11 mg/g, P=0.29) were similar in IFG and normal glucose donors.

Carefully screened prediabetic living kidney donors often revert to normal fasting glucose and do not seem to have a significantly increased risk of impaired kidney function in the short term.