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Published on: July 3, 2013
Development of a Screening Tool to Predict Chronic Kidney Disease Risk in Post-nephrectomy Living Kidney Donors
1Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Living kidney donors face long-term risks, with over 30% developing chronic kidney disease (CKD) within a year of nephrectomy. This study developed a model to predict CKD risk in these donors.
Area of Science:
- Nephrology
- Transplant Surgery
- Public Health
Background:
- Kidney transplantation frequency is increasing, yet long-term risks for living kidney donors remain understudied.
- Donor nephrectomy, the surgical removal of a kidney from a living donor, carries potential risks that require careful consideration.
- Understanding post-nephrectomy outcomes is crucial for donor safety and informed consent.
Purpose of the Study:
- To develop and validate prediction models for chronic kidney disease (CKD) in living kidney donors one year after nephrectomy.
- To identify key variables associated with the onset of CKD in the post-nephrectomy period.
- To provide a tool for assessing donor risk and guiding post-operative surveillance strategies.
Main Methods:
- A prospective cohort study included 440 living kidney donors who underwent nephrectomy between March 2006 and December 2016.
- Exclusion criteria included pre-existing CKD or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m².
- Logistic regression models were used to predict CKD, defined as eGFR <60 mL/min/1.73 m² at 1-year follow-up, using the abbreviated Modification in Diet and Renal Disease Study equation.
Main Results:
- A total of 144 (32.7%) donors developed new-onset CKD within one year after nephrectomy.
- The developed logistic regression model, utilizing three key variables, demonstrated strong predictive performance.
- The model achieved an area under the receiver operating characteristic curve of 0.796, with 70.9% accuracy, 66.2% sensitivity, and 80.6% specificity.
Conclusions:
- A significant proportion of living kidney donors develop CKD within the first year post-nephrectomy.
- The developed prediction model offers a valuable tool for identifying at-risk donors.
- This model can aid in clinical decision-making regarding donor suitability and inform targeted surveillance protocols for post-nephrectomy CKD.
Abstract:
Few studies have examined the long-term risks of kidney removal to donors despite the increase of frequency in kidney transplantation. This is the 1st study to develop prediction models of chronic kidney disease (CKD) for the 1-year period after donor nephrectomy in living donors. A prospective cohort of patients who underwent donor nephrectomy from March 1, 2006, to December 31, 2016, at the Severance Hospital, Seoul, South Korea, was used. CKD was defined as a glomerular filtration rate (GFR) <60 mL/min/1.73 m2. GFR was estimated with the use of the abbreviated Modification in Diet and Renal Disease Study equation. Patients with a previous CKD history or estimated GFR <60 mL/min/1.73 m2 were excluded, and those with 1-year post-nephrectomy follow-up were included. Among 440 patients who underwent donor nephrectomy, 144 (32.7%) developed a first-time onset of a GFR <60 mL/min/1.73 m2 by 1 year after surgery. Our logistic regression models derived from these 3 variables predicted CKD with an area under the receiver operating characteristic curve of 0.796, an accuracy of 70.9%, and a sensitivity of 66.2% and specificity of 80.6%. This model could assist with decision making about potential donors and for surveillance of those at risk of post-nephrectomy CKD.
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