Living Kidney Donation: Glomerular Filtration Rate-Based Donor Selection Criteria

Despite different guidelines and recommendations for evaluating the renal function of living kidney donors, there is still no consensus about the best approach. It is uncertain whether to have measured glomerular filtration rate, estimated it, or both. The absolute value, body surface area-dependent, and age-specified estimated glomerular filtration rates have not been consistent across different populations and practices. The increasing demand for donors has mandated clear selection criteria for glomerular filtration rate. Thus, the next big question is how low should the glomerular filtration be? Indeed, a low level would preclude the misclassification of donors and mitigate future donor risks of chronic kidney disease. The recent consensus on removing factors on race and ethnicity in the estimated glomerular filtration rate equations added a new perspective to the concept of donor assessment of glomerular filtration rate. Furthermore, the increasing use of point of care devices to assess creatinine and estimated glomerular filtration rate will be a paradigm shift in the practice of nephrology. These challenges and updates make glomerular filtration rate-based donor selection criteria an always timely topic in living kidney donation.