Assessing Renal Function for Kidney Donation. How Low Is Too Low?

Gustavo Laham,Gervasio Soler Pujol,Juan Pablo Ponti

doi:10.3389/fmed.2021.784435

Abstract

Kidney transplantation (KT) is the treatment of choice for patients with end-stage kidney disease (ESKD) with decreased morbi-mortality, improved life quality, and reduced cost. However, the shortage of organs from deceased donors led to an increase in KT from living donors. Some stipulate that living donors have a higher risk of ESKD after donation compared with healthy non-donors. The reason for this is not clear. It is possible that ESKD is due to the nephrectomy-related reduction in glomerular filtration rate (GFR), followed by an age-related decline that may be more rapid in related donors. It is essential to assess donors properly to avoid rejecting suitable ones and not accepting those with a higher risk of ESKD. GFR is a central aspect of the evaluation of potential donors since there is an association between low GFR and ESKD. The methods for assessing GFR are in continuous debate, and the kidney function thresholds for accepting a donor may vary according to the guidelines. While direct measurements of GFR (mGFR) provide the most accurate evaluation of kidney function, guidelines do not systematically use this measurement as a reference. Also, some studies have shown that the GFR decreases with age and may vary with gender and race, therefore, the lower limit of GFR in patients eligible to donate may vary based on these demographic factors. Finally, it is known that CrCl overestimates mGFR while eGFR underestimates it, therefore, another way to have a reliable GFR could be the combination of two measurement methods.

Highlights

The number of patients with end-stage kidney disease (ESKD) requiring dialysis is increasing around the world [1]
Renal transplantation (RT) is the best treatment option for patients reaching ESKD because it is associated with better patient survival, quality of life, and lower costs compared with patients remaining on dialysis [9]
A non-language restricted search was performed until August 30, 2021 in PubMed, SciELO, Trip Database, Google Scholar, and MEDES y MEDLINE, using the following MeSH terms and key words, “living kidney donors,” “chronic kidney disease,” “donor nephrectomy,” “glomerular filtration rate,” “estimate glomerular filtration rate,” “glomerular filtration rate,” “glomerular filtration rate measurements,” “cystatin C,” “CKD-EPI,” “modification of diet in renal disease (MDRD),” “creatinine clearance,” “inulin,” “iothalamate,” “diethylenetriaminepentaacetic acid,” “iohexol,” and “ethylenediamine tetra-acetic acid.”

Summary

Introduction

The number of patients with end-stage kidney disease (ESKD) requiring dialysis is increasing around the world [1]. This has been mainly attributed to the rising prevalence of diabetes mellitus (DM) and hypertension (HTN) in an elder population that reaches this stage [2]. Not surprisingly this is associated with increased morbidity, mortality, healthcare costs, and reduced quality of life [3,4,5,6,7].

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