Subclinical Risk Predictors and Recovery Trajectories for Estimated Glomerular Filtration Rate Among Indian Living...

In the Indian subcontinent, data on clinical outcomes of living kidney donors remain scarce. We aimed to evaluate renal outcomes after kidney donation using estimated glomerular filtration trajectory-based analysis.

In this retrospective single-center study, we analyzed 300 living kidney donors who underwent nephrectomy between January 1 and December 31, 2019, at a tertiary transplant center. Only donors who completed at least 2 years of follow-up were studied. Primary outcome measures were new-onset hypertension, proteinuria, and decline of estimated glom erular filtration below 60 mL/min. Secondary outcomes were estimated glomerular filtration rate trajectories stratified by sex for baseline levels, systolic blood pressure, body mass index, and peak creatinine during admission. Predictors of proteinuria were investigated by Cox regression.

At median follow-up of 25.7 months, 14.3% of donors developed de novo hypertension, 9.3% developed proteinuria, and 6.0% had estimated glomerular filtration rate <60 mL/min/1.73 m². Trajectory analysis showed a biphasic pattern of estimated glomerular filtration rate trend, characterized by an initial decline followed by stabilization after 6 to 12 months. Donors with elevated systolic blood pressure and obesity demonstrated a steeper drop in estimated glomerular filtration rate and flatter recovery slopes compared with donors with normal systolic blood pressure. Male donors with higher perioperative peak serum creatinine showed delayed recovery. In contrast, donors with low systolic blood pressure and normal body mass index had better trajectory estimated glomerular filtration rate after donation.

In this first Indian study to use trajectory-based modeling for stratifying risk in living kidney donors after donation, kidney donation practices remain safe but also call for structured and personalized follow-up protocols for candidates with increased risk.