Abstract

BackgroundPreoperative characteristics of living kidney donors are commonly considered during donor selection and postoperative follow-up. However, the impact of preoperative uric acid (UA) levels is poorly documented. The aim of this study was to evaluate the association between preoperative serum UA levels and post-donation long-term events and renal function.MethodsThis was a single-center retrospective analysis of 183 living kidney donors. The donors were divided into high (≥5.5 mg/dl) and low (< 5.5 mg/dl) UA groups. We analyzed the relationship between preoperative UA levels and postoperative estimated glomerular filtration rate (eGFR), as well as adverse events (cardiovascular events and additional prescriptions for hypertension, gout, dyslipidemia, and diabetes mellitus), over 5 years after donation.ResultsIn total, 44 donors experienced 52 adverse events over 5 years. The incidence of adverse events within 5 years was significantly higher in the high UA group than in the low UA group (50% vs. 24%, p = 0.003); this was true even after the exclusion of hyperuricemia-related events (p = 0.047). UA emerged as an independent risk factor for adverse events (p = 0.012). Donors with higher UA levels had lower eGFRs after donation, whereas body mass index, hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol did not have any impact on the eGFR.ConclusionsThe findings suggest that preoperative UA levels should be considered during donor selection and postoperative follow-up.

Highlights

  • Living donor kidney transplantation is one of the established treatment options for patients with endstage renal diseases (ESRDs) [1, 2]

  • Preoperative uric acid (UA) levels (HR [per 1 mg/dl]: 1.643, 95% confidence interval [Confidence interval (CI)]: 1.248–2.163, p < 0.001), body mass index (BMI) (HR [per 1 kg/m2]: 1.278, 95% CI: 1.131–1.445, p < 0.001), blood pressure (BP) (HR [per 10 mmHg]: 1.884, 95% CI: 1.447–2.454, p < 0.001), and low-density lipoprotein cholesterol (LDL-C) (HR [per 10 mg/dl]: 1.272, 95% CI: 1.127–1.435, p < 0.001) were significantly associated with a higher incidence of adverse events in the 5 years after donation (Table 2)

  • UA, BP, and LDL-C levels emerged as independent risk factors for the development of adverse events

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Summary

Introduction

Living donor kidney transplantation is one of the established treatment options for patients with endstage renal diseases (ESRDs) [1, 2]. Uric acid (UA) is known to induce endothelial dysfunction by reactive oxygen production, [9] inflammation and vasoconstriction by various mechanisms, [10, 11] and increased cyclooxygenase-2 expression [12]. Through these mechanisms, hyperuricemia exacerbates vascular disorders, [13,14,15,16] renal arteriolar damage, [17, 18] and glomerulosclerosis [10]. The aim of this study was to evaluate the association between preoperative serum UA levels and post-donation longterm events and renal function

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