Abstract
BackgroundThe magnitude of renal function recovery after kidney donation differs in donors with a heterogeneous background. Preoperative assessment of candidates with potentially unfavorable renal functional compensation is critical when baseline kidney function is marginal. We explored the significance of preserved kidney volume (PKV) and known preoperative risk factors for the prediction of unfavorable renal function compensation.MethodsWe enrolled 101 living donors for whom a 1-mm sliced enhanced computed tomography scan was performed preoperatively and clinical data could be collected up to 1 year after donation. The donors whose estimated glomerular filtration rate (eGFR) at 1 year after donation was 70% or higher of baseline eGFR were assigned to the “favorable renal compensation” group and the others to the “unfavorable renal compensation” group.ResultsAge, sex, and preoperative serum uric acid level were not significant predictors for “unfavorable renal compensation.” Multivariable logistic regression analysis revealed that body mass index (BMI) and body surface area (BSA)-adjusted PKV were independent preoperative risk factors for “unfavorable renal compensation” (adjusted odds ratio, 1.342 and 0.929, respectively). Hypertension and preoperative eGFR were not independent predictors when adjusted with BMI and BSA-adjusted PKV. Receiver operative characteristic analysis revealed that the predictive equation with the two independent predictors yielded a good accuracy to detect donor candidates with unfavorable renal functional compensation (area under the curve = 0.803), and the optimal cut-off values were identified as 23.4 kg/m2 for BMI and 107.3 cm3/m2 for BSA-adjusted PKV.ConclusionsBMI and BSA-adjusted PKV may be useful to select candidates with potentially unfavorable renal function compensation before kidney donation.
Highlights
The magnitude of renal function recovery after kidney donation differs in donors with a heterogeneous background
The correlation coefficient of this analysis was 0.725. These results demonstrated that modified Modification of Diet in Renal Disease (MDRD) estimated glomerular filtration rate (eGFR) more underestimated creatinine clearance (CCr) in each individual
Our findings demonstrated that body mass index (BMI), and body surface area (BSA)-adjusted preserved kidney volume (PKV) calculated by the 3-D reconstructed image using a thin-sliced computed tomography (CT) scan were significant preoperative predictors for patients who lose >30% of eGFR at 1 year after kidney donation
Summary
The magnitude of renal function recovery after kidney donation differs in donors with a heterogeneous background. A recent report using a Norwegian cohort, which clearly disclosed exclusion criteria (e.g., age, body mass index [BMI], blood pressure [BP], BP medication, diabetes, and cardiovascular disease) of the donor and control cohorts, demonstrated that the risk of all-cause and cardiovascular deaths in the kidney donors was relatively higher than that in the controls. It showed that the risk of end-stage renal disease (ESRD) was unexpectedly much higher than in the controls (hazard ratio, 11.38) [4]. When baseline kidney function of donor candidates is marginal, it is very important to assess which candidates have a potential of unfavorable renal function compensation before kidney donation
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