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Published on: June 16, 2014
Aortic stiffness after living kidney donation: a systematic review and meta-analysis
Rosendo A Rodriguez1, Kylie McNeill2, Mohsen Agharazii3
1Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada rrodriguez1847@gmail.com.
Insights
Living kidney donation increases aortic stiffness one year post-donation, but long-term effects are minimal. This finding may influence donor consent discussions regarding cardiovascular health.
Area of Science:
- Cardiovascular Science
- Nephrology
- Transplantation Medicine
Background:
- Increased aortic stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV), is linked to adverse cardiovascular outcomes.
- Previous studies suggest elevated cf-PWV in living kidney donors post-nephrectomy.
Purpose of the Study:
- To evaluate the impact of living kidney donation on cf-PWV, glomerular filtration rate (GFR), and blood pressure (BP).
- To compare cf-PWV, GFR, and BP changes in kidney donors versus non-nephrectomized healthy individuals.
Main Methods:
- Systematic review and meta-analysis of studies measuring cf-PWV in living kidney donors before and after nephrectomy.
- Inclusion of non-nephrectomized healthy individuals as controls and analysis of age-adjusted cf-PWV reference values.
- Data extraction, risk of bias assessment (ROBINS-I), quality of evidence evaluation (GRADE), and pooled effect estimation using random-effects models.
Main Results:
- cf-PWV was significantly higher at 1-year post-donation (0.4 m/s increase) compared to healthy controls (p=0.01).
- GFR decreased post-nephrectomy (p<0.001) and remained lower than controls (p<0.001); systolic and diastolic BP showed no significant differences.
- The difference in cf-PWV between donors and controls was non-significant at 5 years post-donation (p=0.54).
Conclusions:
- Aortic stiffness increases one year after kidney donation, independent of blood pressure.
- Long-term effects of kidney donation on aortic stiffness appear minimal.
- Findings may inform consent processes for prospective living kidney donors regarding cardiovascular implications.
Objectives:
Increased aortic stiffness measured with carotid-femoral pulse wave velocity (cf-PWV) has been associated with adverse cardiovascular outcomes. Some studies have reported increased cf-PWV in living kidney donors after nephrectomy. This review aimed to determine the effects of living kidney donation on cf-PWV, glomerular filtration rate (GFR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and their differences versus non-nephrectomised healthy individuals.
Design:
Systematic review and meta-analysis.
Data Sources:
Electronic databases (MEDLINE, EMBASE, Cochrane Central databases, Cochrane Register of Controlled Trials, Cochrane Methodology Register, Health Technology Database, Technologies in Health, EBM Reviews, ProQuest and 'Grey Matters Light'). Databases were searched from inception to December 2022.
Eligibility Criteria:
We searched for studies that measured cf-PWV in living kidney donors before and/or after nephrectomy. Non-nephrectomised healthy individuals included as controls were the comparators. Studies that provided age-adjusted cf-PWV reference values in normotensive healthy individuals were also included.
Outcome Measures:
We evaluated the mean differences in cf-PWV, GFR and BP before-and-after nephrectomy and their mean differences versus non-nephrectomised healthy comparators. We also explored differences in yearly adjusted cf-PWV changes between donors and normotensive healthy individuals.
Data Extraction/Synthesis:
Two independent reviewers extracted data and assessed risk of bias (Risk of Bias tool for non-Randomised studies: ROBINS-I) and quality of evidence (GRADE). Pooled effect estimates were calculated using the inverse variance method and analysed with random effect models.
Results:
Nine interventional (652 donors; 602 controls) and 6 reference studies (6278 individuals) were included. cf-PWV increased at 1-year postdonation (p=0.03) and was on average 0.4 m/s (95% CI 0.07; 0.60) higher than in healthy controls (p=0.01). These differences were non-significant 5 years postnephrectomy (p=0.54). GFR decreased after nephrectomy (p<0.001) and remained reduced compared with healthy controls (p<0.001), but SBP and DBP were not significantly different (p≥0.14). Yearly changes in cf-PWV postnephrectomy were similar to age-adjusted reference values in healthy normotensive individuals (p=0.76).
Conclusions:
Aortic stiffness increases independent of BP 1 year after kidney donation, but the long-term effects seem minimal. These findings may impact future consent of prospective living kidney donors.
Prospero Registration Number:
CRD42020185551.
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