Increased Serum Sodium Values in Brain-dead Donor's Influences Its Long-term Kidney Function

Abstract

BackgroundKidney transplantation in Poland predominantly (95%) involves brain dead donors that display associated endocrine disorders. Diabetes insipidus, the most common complication, results in hypernatremia, hypovolemia, and increased plasma osmolality. Hypernatremia in donors is one of the strongest risk factors for the loss of a transplanted liver or heart. However, the influence of donor hypernatremia on early and late kidney graft function has not been entirely established to date. Methods and ResultsWe analyzed data for 80 kidney recipients from 54 brain dead donors during 2006–2008. Donors showed a positive correlation between serum sodium and creatinine concentrations (P = .001) and a negative correlation between serum sodium concentrations and creatinine clearances (P < .005). Donors divided into two groups based on a median sodium concentration of 155 mM revealed significantly lower values of glomerular filtration rate in recipients of the group with sodium concentrations >155 mM. ResultsNo relationship was observed between donor serum sodium concentration and early or 1-year function. There was a negative correlation between donors serum sodium concentration and creatinine clearance in recipients at 2, 3, and 4 years after kidney transplantation (P = .008, .00033, and .02, respectively). Multivariate analysis confirmed the influence of donor sodium concentration on creatinine clearance at 2 and 3 years after renal transplantation (P < .05 and P > .01, respectively). ConclusionHigh serum sodium concentrations and increased plasma osmolality in brain dead kidney donors adversely affect long-term graft function probably due to initiation of an inflammation processes.