Abstract
Single-kidney glomerular filtration rate (GFR) increases after living kidney donation due to compensatory hyperfiltration and structural changes. The implications of inter-individual variability in this increase in single-kidney GFR are unknown. Here, we aimed to identify determinants of the increase in single-kidney GFR at three-month postdonation, and to investigate its relationship with long-term kidney function. In a cohort study in 1024 donors, we found considerable inter-individual variability of the early increase in remaining single-kidney estimated GFR (eGFR) (median [25th-75th percentile]) 12 [8-18] mL/min/1.73m2. Predonation eGFR, age, and cortical kidney volume measured by CT were the main determinants of the early postdonation increase in single-kidney eGFR. Individuals with a stronger early increase in single-kidney eGFR had a significantly higher five-year postdonation eGFR, independent of predonation eGFR and age. Addition of the postdonation increase in single-kidney eGFR to a model including predonation eGFR and age significantly improved prediction of a five-year postdonation eGFR under 50 mL/min/1.73m2. Results at ten-year follow-up were comparable, while accounting for left-right differences in kidney volume did not materially change the results. Internal validation using 125I-iothalamate-based measured GFR in 529 donors and external validation using eGFR data in 647 donors yielded highly similar results. Thus, individuals with a more pronounced increase in single-kidney GFR had better long-term kidney function, independent of predonation GFR and age. Hence, the early postdonation increase in single-kidney GFR, considered indicative for kidney reserve capacity, may have additional value to eGFR and age to personalize follow-up intensity after living kidney donation.
Highlights
I n 1930, Ernest Basil Verney postulated that the kidney has reserve forces, a dormant renal reserve intended to cope with extraordinary hemodynamic and metabolic demands.1 In line with this concept, donor nephrectomy is followed by an adaptive increase in glomerular filtration rate (GFR) by w30% in the remaining kidney.2–4 little is known about underlying mechanisms and determinants, early hemodynamic changes and structural adaptations of the remaining nephrons are generally considered to explain this increase.5 A recent study identified a low nephron number for age as a predictor for longterm risk of chronic kidney disease after living kidney donation.6 Whether reduced nephron number or cortical kidney volume, which has been linked with postdonation kidney function,7,8 are associated with a less pronounced postdonation increase in single-kidney GFR is unknown
This study aimed to investigate the predictive value of shortterm postdonation kidney function adaptation, defined as the postdonation increase in single-kidney GFR, for long-term postdonation GFR
We found that the postdonation increase in single-kidney GFR improves the prediction of long-term postdonation kidney function beyond predonation measured glomerular filtration rate (mGFR) and age
Summary
I n 1930, Ernest Basil Verney postulated that the kidney has reserve forces, a dormant renal reserve intended to cope with extraordinary hemodynamic and metabolic demands. In line with this concept, donor nephrectomy is followed by an adaptive increase in glomerular filtration rate (GFR) by w30% in the remaining kidney. little is known about underlying mechanisms and determinants, early hemodynamic changes and structural adaptations of the remaining nephrons are generally considered to explain this increase. A recent study identified a low nephron number for age as a predictor for longterm risk of chronic kidney disease after living kidney donation. Whether reduced nephron number or cortical kidney volume, which has been linked with postdonation kidney function, are associated with a less pronounced postdonation increase in single-kidney GFR is unknown. I n 1930, Ernest Basil Verney postulated that the kidney has reserve forces, a dormant renal reserve intended to cope with extraordinary hemodynamic and metabolic demands.1 In line with this concept, donor nephrectomy is followed by an adaptive increase in glomerular filtration rate (GFR) by w30% in the remaining kidney.. The impact of the postdonation increase in single-kidney GFR on long-term postdonation kidney function remains unknown. Previous studies identified age and predonation GFR as major predictors of long-term postdonation kidney function, Kidney International (2022) 101, 1251–1259 clinical investigation. In the present study, we hypothesized that the early postdonation increase in single-kidney GFR predicts long-term postdonation kidney outcomes. We first aimed to identify predonation determinants of this increase and subsequently investigated its capacity to predict long-term kidney function after donation
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