Donor Glomerular Filtration Rate Research Articles

A Single-Center Study on the Clinical Profiles and Ultrasonographic Assessments of Living Kidney Donors in the Marathwada Region of Maharashtra.

Living donor kidney transplantation plays a vital role in renal replacement therapy, particularly in India, where a substantial increase in kidney transplants has been observed. Thorough assessments of living kidney donors are crucial, focusing on parameters such as kidney size and glomerular filtration rate (GFR). Despite the importance of GFR in donor assessments, there is a noticeable lack of data on normal GFR ranges in the Indian population. This study aims to address the gap in knowledge by establishing a reference range for GFR in healthy kidney donors from the Marathwada region of Maharashtra. The research also explores the clinical profiles and ultrasonographic features of living kidney donors. A retrospective analysis was conducted at the Mahatma Gandhi Mission (MGM) Medical College and Hospital in Aurangabad, involving 134 living kidney donors. Inclusion criteria encompassed healthy donors with a BMI of less than 30 kg/m², while donors with uncontrolled hypertension, diabetes, microalbuminuria, or a measured GFR below 70 mL/min/1.73 m² were excluded. Comprehensive medical histories, demographic parameters, and ultrasonographic assessments were conducted, with GFR measured using 99M technetium diethylenetriamine pentaacetate scans. The study reveals that the majority of donors were females (80.6%), and the highest number fell within the 41-50 age group. Parents constituted the primary donor category (68.7%), reflecting a familial inclination toward organ donation. Ultrasonographic assessments indicated larger kidney sizes compared to other studies, suggesting regional or population-specific differences. The mean GFR for the right and left kidneys, as well as the total GFR, was within the expected range. The negative correlation between age and GFR emphasizes the need to consider age in donor assessments. The findings emphasize the unique features of this population, including a higher average age, female preponderance, and larger kidney sizes. The study contributes to the understanding of living kidney donors' profiles in the region and highlights the importance of individualized assessments in the donor selection process.

Predictive Value of Camera-based Donor Glomerular Filtration Rate Estimation on the Immediate Renal Allograft Outcome Following Live-related Renal Transplant: A Single-center Retrospective Study.

The purpose of this study was to assess the association of measured glomerular filtration rate (mGFR) using camera-based method with early transplant outcomes. Diethylenetriamine pentaacetate renograms of all voluntary kidney donors between January 2016 and December 2022 at Kasturba Hospital, Manipal, India, were retrieved for the study. Recipients' posttransplant biochemical parameters were collected and compared against donors with scaled mGFR >80 ml/min/1.73 m2 (Group 1) and with mGFR between 60 and 80 ml/min/1.73 m2 (Group 2). Donor-recipient pair age, anthropometric parameters, and their differences were also assessed against the immediate transplant outcome. Posttransplant immediate graft function was assessed by posttransplant nadir serum creatinine, day to achieve nadir serum creatinine, the incidence of slow graft or delayed graft function, and serum creatinine at 1-month posttransplantation. Recipients with serum creatinine of >2.5 mg/dl on posttransplant day 7 were taken as slow graft function. A total of 161 donor-recipient pairs were analyzed in the study. In recipients who showed persistently high serum creatinine posttransplant, older donor age(p < 0.001), higher difference in body mass index among the donor-recipient pair (p= 0.03), and mGFR <80ml/min (p < 0.001) were significantly associated. Slow graft function was significantly more in Group II recipients, with donors having mGFR <80ml/min as compared to Group I with mGFR >80 ml/min (37.3% vs. 10.6%) (P < 0.001). Camera-based mGFR using Gates' formula is a reliable tool to predict inferior graft outcomes in the immediate posttransplant period. Kidneys from donors with mGFR of 60-80 mL/min/1.73 m2 are likely to experience slow graft function in the immediate posttransplant period.

Impact of Particulate Matter With an Aerodynamic Diameter

Ambient air pollution has become 1 of the most important public health issues worldwide. In particular, particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) is a fatal component of air pollution. We aimed to analyze whether perioperative exposure to PM2.5 is associated with the deterioration of renal function in living kidney donors. This study was conducted on 232 kidney donors with postoperative 2-year glomerular filtration rate (GFR). The GFR was determined by serum creatinine-based method using the Modification of Diet in Renal Disease equation and radionuclide-based method using 99mTc-DTPA renal scintigraphy. Perioperative exposure to PM2.5 was calculated using data from the AIRKOREA System. Multiple linear and logistic regression analyses were performed to estimate the associations between mean PM2.5 concentration and postoperative 2-year GFR. Postoperative Modification of Diet in Renal Disease-estimated GFRs of kidney donors with low PM2.5 concentrations were significantly higher than those of those with high PM2.5 concentrations. A 1-μg/m3 increase in mean PM2.5 concentration was associated with decreased GFR by 0.20 mL/min/1.73 m2. In addition, a 1-μg/m3 increase in mean PM2.5 concentration was associated with an 11% increased risk of chronic kidney disease stage ≥3 at 2 years after donor nephrectomy. In patients who underwent donor nephrectomy, exposure to PM2.5 negatively affects renal function and is positively associated with the prevalence of chronic kidney disease.

Twenty-year survival following lung transplantation.

Lung transplantation median survival has seen improvements due to recognition of short-term survival factors but continues to trail behind other solid organs due to limited understanding of long-term survivorship. Given the creation of the United Network for Organ Sharing (UNOS) database in 1986, it was difficult to accrue data on long-term survivors until recently. This study characterizes factors impacting lung transplant survival beyond 20 years, conditional to 1-year survival. Lung transplant recipients listed in UNOS from 1987 to 2002 who survived to 1 post-transplant year were reviewed. Kaplan-Meier and adjusted Cox regression analyses were performed at 20 and 10 years to identify risk factors associated with long-term outcomes independent of their short-term effects. A total of 6,172 recipients were analyzed, including 472 (7.6%) recipients who lived 20+ years. Factors associated with increased likelihood of 20-year survival were female-to-female gender match, recipient age 25-44, waitlist time >1 year, human leukocyte antigen (HLA) mismatch level 3, and donor cause of death: head trauma. Factors associated with decreased 20-year survival included recipient age ≥55, chronic obstructive pulmonary disease/emphysema (COPD/E) diagnosis, donor smoking history >20 pack-years, unilateral transplant, blood groups O&AB, recipient glomerular filtration rate (GFR) <10 mL/min, and donor GFR 20-29 mL/min. This is the first study identifying factors associated with multiple-decade survival following lung transplant in the United States. Despite its challenges, long-term survival is possible and more likely in younger females in good waitlist condition without COPD/E who receive a bilateral allograft from a non-smoking, gender-matched donor of minimal HLA mismatch. Further analysis of the molecular and immunologic implications of these conditions are warranted.

Correlation of Differential Function and Glomerular Filtration Rate Estimated from Computed Tomography based Renal Volume and Diuretic Renogram in Living Renal Donor

Introduction: In renal transplant, serum creatinine and isotope studies are used for determination of donor glomerular filtration rate (GFR). Studies have shown computed tomography measured renal volume can also be used. Our main objective was to assess the accuracy of volume based estimated GFR (vGFR) with diethylene triamine penta acetic acid (DTPA) measured GFR in living kidney donors. Methods: An observational analytical study was conducted from July 2018 to June 2019 in Department of Urology and Kidney Transplant Surgery and Department of Radiodiagnosis in Tribhuvan University Teaching Hospital where a total of 38 eligible potential donors were evaluated and serum creatinine level, computed tomography with contrast and DTPA renogram were used to measure GFR and differential function. Results: The mean age of the donors were 42.8±10.9 years with 70% of donors being females. Renal volume was not statistically different between male and female donors. There was moderate correlation between volume based and DTPA based GFR (r=0.76) and differential function (r=0.71). Compared to creatinine, volume based GFR estimate showed better correlation to DTPA renogram. There was no significant difference in differential function estimated by DTPA and volume based estimates (p = 0.96). The upper and lower limit of agreement between the volume based and DTPA based differential function was –4.7 and 4.6 respectively. Conclusion: GFR measurement by CT volume overestimates total GFR compared to DTPA renogram but it has better correlation than creatinine based estimates. It can be used to estimate the differential function of the donor kidney.

Timed Creatinine Clearance and Measured Glomerular Filtration Rate in Living Kidney Donors

Assessment of predonation glomerular filtration rate (GFR) is a key aspect of the evaluation of potential living kidney donors. In the United States, measurement of donor GFR is a regulatory requirement and most commonly assessed using 24-hour timed creatinine clearance (CrCl24), despite the potential for error due to incorrectly timed urine sample collection and tubular creatinine secretion.1,2 We aimed to determine the real-world performance of CrCl24 in living donor candidates.

423.8: Live Donated Kidneys Don’t Behave Like the One Left Behind

Introduction: Following live kidney donation (LD), the donor glomerular filtration rate (GFR) increases for the initial 5 years1, especially in younger donors. We queried whether the recipients of younger LD kidneys would have a similar eGFR increase. Methods: The medical records of primary LD and DD adult kidney alone recipients at a single center performed between 1/1/10-6/30/21 were analyzed. 62,371 eGFR calculations (CKD-EPI) were available between 3-36 months post-transplant for 1186 recipients. Restricted cubic splines were used to analyze the trajectory of eGFR from 3-36 months post-transplant recipients of kidneys from donors 18-35, 35-55 and >55 years. Slopes were constructed separately from 3-9, 9-21 and 21-36 months. A mixed effects model was utilized to calculate predicted eGFR for donor type/age group, separately for male and female donors (21 additional recipients excluded due to lack of donor gender data). An analysis adjusting for BSA was completed with similar results. Model results are presented in Table 1. All analyses were performed in R, ver. 4.1.1. Results: The eGFR varied by donor age and gender. Kidneys (DD and LD) from women on aggregate provided lesser eGFR than male donors (Table 1). However, predicted eGFR change was similar when grouped by gender and age of DD and LD kidneys. Compared to recipients of LD aged 35-55, DD kidneys 18-35 years had an eGFR +10.339 mL/min/1.73m2 from female donors and +8.423 mL/min/1.73m2 difference from males. For DD 35-55 years, -2.333 mL/min/1.73m2 difference from females and -2.092 mL/min/1.73m2 from males, with a larger difference in the LD >55 year age group -5.478 mL/min/1.73m2 difference with females and -5.479 mL/min/1.73m2 difference with males. In a separate analysis, no observed differences in the rate of eGFR change was noted from recipient age, gender or race. The p-values (Table 1) are based on an eGFR difference from 0 mL/min/1.73m2, many p-values while statistically significant, may not be clinically significant.Gender is significant. Males tend to have more kidney mass and greater BSA. If the recipient is a female and the donor a male, a higher eGFR is expected, conversely in a male receiving a female kidney. 59.7% of the recipients of female kidneys were male. Of the recipients of male kidneys, 56.4% were male. Overall, a slightly higher eGFR in recipients of male kidneys at 3 months and 3 years was observed. Conclusion: The post-donation increase of eGFR observed after live kidney donation did not occur in the recipients of LD kidneys. The overall trajectory of LD and DD kidney transplant eGFR during the first 3 post-transplant years is similar within the age/donor type groups. Donor age and gender (more likely amount of renal mass) are important factors determining eGFR. 1.Matas AJ, Vock DM, Ibrahim HN. GFR ≤25 years postdonation in living kidney donors with (vs. without) a first-degree relative with ESRD. Am J Transplant. 2018;18:625–631.

Living Kidney Donation Criteria of Baskent University.

Kidney transplant is the best treatment for patients with end-stage renal disease. Preparation of living related kidney donors and recipients is the major step to achieve their best long-term outcomes. Here, we present the Baskent University criteria for living kidney donors and recipients. The Baskent team has performed >2000 kidney transplants from 1985 to 2022 under leadership of Prof. Mehmet Haberal, a transplantation pioneer in Turkey, who facilitated Turkish legislation on procurement, storage, engraftment, and transplant of organs and tissues in June 1979, which has been adopted in other countries with few changes. Although the main frame is similar, we have constant principles in kidney donation. Baskent University is now known as an exceptional transplant center in Turkey, the Middle East, Europe, and the world and has established its own donor criteria for both kidney and liver transplant. Volunteerism remains a core principle of living kidney donation, regardless of other criteria. At Baskent University, donor protection from social, psychological, and health problems is paramount. Loss-profit and risk of transplant are assessed for every case. Donors must be followed up and remedies sought for failed criteria. Dr. Haberal's principles are the basis of Baskent University donation criteria, and unrelated kidney transplant donors are accepted only in cases of cross-donation. Major distinctions of Baskent University's living related donor criteria are (1) absence of unrelated or nondirected donation, (2) lowest acceptable donor glomerular filtration rate of 100 mL/min, (3) rejection of hypertensive donor candidates (regardless of medication), and (4) obesity must be corrected before transplant if body mass index (measured as body weight in kilograms divided by height in meters squared) is >30. The Baskent University donor selection criteria provide excellent long-term outcomes of kidney donors that have been proved by our recent studies.

Prediction of Renal Function in Living Kidney Donors and Recipients of Living Donor Kidneys Using Quantitative Histology.

Living kidney donors (LKDs) are at increased risk of chronic kidney disease, whereas transplant recipients experience progressive reduction of graft function. We examined the predictive value of quantitative stereology on renal function in LKDs and recipients of living donor kidneys, based on perioperative biopsies from the donated kidney. Cortex volume of both donor kidneys was determined by contrast-enhanced computed tomography and single-kidney glomerular filtration rate (GFR) by 51 chrome-EDTA clearance together with renography. Glomerular density was used to estimate total glomeruli number in addition to glomerular volume, glomerular sclerosis, kidney fibrosis, and arteriole dimensions. GFR measurements were repeated 1 y after transplantation in both LKDs and recipients. Associations between GFR at follow-up and cortex volume and histomorphometric parameters after adjustment of age, gender, body mass index, smoking status, 24-h blood pressure, and single-kidney GFR were examined. We included 49 LKDs (age, 51 ± 12 y) and 51 recipients (age, 44 ± 13 y). At follow-up, GFR was 71 ± 16 mL/min in LKDs and 61 ± 18 mL/min in recipients with hyperfiltration being more prominent in LKDs (30.4%) as compared to recipients (16.4%; P < 0.05). One-year GFR in donors correlated to cortex volume ( P < 0.001) but not to any histological parameters, whereas GFR in recipients correlated to the amount of interstitial fibrosis ( P < 0.01) but not to other histological parameters or cortex volume. Kidney cortex volume, but not renal histology parameters, predicts 1-y renal outcome in LKDs. In contrast, the amount of interstitial fibrosis, but not cortex volume, predicts 1-y graft function in recipients.

Comparison of creatinine-based glomerular filtration rate estimation equations in voluntary Indian kidney donors: A single centre study

Introduction: In transplantation, accurate estimation of the donor glomerular filtration rate (GFR) is crucial. While various creatinine-based equations are in use, none are validated in Indians. Objectives: This study was conducted to judge the accuracy of creatinine-based GFR estimation equations and urinary creatinine clearance. Patients and Methods: A single-centre, observational and retrospective study at a tertiary care hospital. Adult voluntary donors GFR measured (mGFR) by technetium-99m diethylenetriaminepentaacetic acid (Tc-99m DTPA) were included. The primary outcome was the performance of estimated GFR (eGFR) by "Cockcroft-Gault’s formula corrected for body surface area (CG-BSA) formula", "modification of diet in renal disease (MDRD) 4 and 6 variable equation" and "Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation"; secondary outcome was the performance of "24-hour urinary creatinine clearance (Cr Cl)". Results: 102 kidney donors were analysed with mean age of 45.89 ± 9.98 years and 85.3% females. Mean ± SD mGFR by Tc-99m DTPA was 82.11 ± 14.32 mL/min/1.73 m2 . Mean ± SD eGFR by "CGBSA" was 99.68 ± 23.71 mL/min/1.73 m2 , by "MDRD-4 variable equation" was 98.25 ± 28.61 mL/ min/1.73 m2 , by "MDRD-6 variable equation" was 93.66 ± 19.44 ml/min/1.73 m2 and by "CKD-EPI" was 111.14 ± 31.61 mL/min/1.73 m2 . The lowest bias (2.3), highest precision (16.23), and accuracy (97.1%) were with "MDRD-6 variable equation"; "24-hour urinary Cr Cl" highly overestimated GFR (158.27 mL/min/1.73 m2 ) with the highest bias, lowest precision, and accuracy. Conclusion: The "MDRD-6 variable equation" was the most precise and accurate of the equations, whereas "24-hour urinary Cr Cl" was the least dependable. This study highlights the need for a correction factor or a new GFR estimation equation and not to consider urinary Cr Cl to assess donor GFR.

Evaluation of Donor Glomerular Filtration Rate on Survival Outcomes among Simultaneous Heart and Kidney Transplant Recipients

Purpose Evaluation of donor co-morbidities is critical in order to risk-stratify and optimize post-transplant survival among simultaneous heart and kidney transplant (HKT) patients. We aimed to characterize the effect of donor glomerular filtration rates (GFR) on HKT recipient survival at 60 months post-transplantation. Methods All patients registered in the UNOS database who received HKT from 1/1/2010 - 6/1/2021 were analyzed. HKT recipients with donors of GFR >30 mL/min/1.73 m2 (n =1934) and donors with GFR <=30 mL/min/1.73 m2 (n = 59) were compared. HKT recipients with donors of GFR >60 mL/min/1.73 m2 (n=1611) and <=60mL/min/1.73 m2 (n=382) were also compared. Baseline characteristics were compared using Mann-Whitney U and Chi-square analyses. Mean age among all recipients was 55.8 years (SE 10.8). Comorbidities including diabetes, smoking, pre transplant dialysis requirements, donor age, use of ventricular assist devices, life support ventilators, intra-aortic balloon pumps, and ischemic time were similar among groups. Kaplan-Meier survival analysis was performed at 60 months post-transplantation. Results At 60 months post-transplant, there were no significant differences in survival among HKT patients with donor GFR <=60mL/min/1.73 m2 and donor GFR>60mL/min/1.73 m2 groups, respectively (p=0.858). At 60 months post transplant, there was no significant survival change among those with donor GFR <=30 mL/min/1.73 m2 and >30 mL/min/1.73 m2 (p=0.400). After adjusting for variables listed above, HKT recipients with donors of GFR <=60 compared to >60 had similar survival rates (adjusted HR 1.016, 95% CI 0.776-1.332, p=0.904). A similar trend was seen for patients with donors of GFR <= 30 mL/min/1.73 m2 compared to those of GFR >30 mL/min/1.73 m2 (adjusted HR 0.650, 95% CI 0.290-1.457, p=0.295). Conclusion Donor GFR in isolation had no significant impact on survival among simultaneous heart kidney transplant recipients at 60 months post transplantation after controlling for comorbidities. Donor kidney function In isolation should also not prohibit consideration for dual organ transplantation. Evaluation of donor co-morbidities is critical in order to risk-stratify and optimize post-transplant survival among simultaneous heart and kidney transplant (HKT) patients. We aimed to characterize the effect of donor glomerular filtration rates (GFR) on HKT recipient survival at 60 months post-transplantation. All patients registered in the UNOS database who received HKT from 1/1/2010 - 6/1/2021 were analyzed. HKT recipients with donors of GFR >30 mL/min/1.73 m2 (n =1934) and donors with GFR <=30 mL/min/1.73 m2 (n = 59) were compared. HKT recipients with donors of GFR >60 mL/min/1.73 m2 (n=1611) and <=60mL/min/1.73 m2 (n=382) were also compared. Baseline characteristics were compared using Mann-Whitney U and Chi-square analyses. Mean age among all recipients was 55.8 years (SE 10.8). Comorbidities including diabetes, smoking, pre transplant dialysis requirements, donor age, use of ventricular assist devices, life support ventilators, intra-aortic balloon pumps, and ischemic time were similar among groups. Kaplan-Meier survival analysis was performed at 60 months post-transplantation. At 60 months post-transplant, there were no significant differences in survival among HKT patients with donor GFR <=60mL/min/1.73 m2 and donor GFR>60mL/min/1.73 m2 groups, respectively (p=0.858). At 60 months post transplant, there was no significant survival change among those with donor GFR <=30 mL/min/1.73 m2 and >30 mL/min/1.73 m2 (p=0.400). After adjusting for variables listed above, HKT recipients with donors of GFR <=60 compared to >60 had similar survival rates (adjusted HR 1.016, 95% CI 0.776-1.332, p=0.904). A similar trend was seen for patients with donors of GFR <= 30 mL/min/1.73 m2 compared to those of GFR >30 mL/min/1.73 m2 (adjusted HR 0.650, 95% CI 0.290-1.457, p=0.295). Donor GFR in isolation had no significant impact on survival among simultaneous heart kidney transplant recipients at 60 months post transplantation after controlling for comorbidities. Donor kidney function In isolation should also not prohibit consideration for dual organ transplantation.

Age-adapted percentiles of measured glomerular filtration in healthy individuals: extrapolation to living kidney donors over 65years.

Most data on glomerular filtration rate (GFR) originate from subjects <65years old, complicating decision-making in elderly living kidney donors. In this retrospective multi-center study, we calculated percentiles of measured GFR (mGFR) in donors <65years old and extrapolated these to donors≥65years old. mGFR percentiles were calculated from a development cohort of French/Belgian living kidney donors <65years (n=1,983), using quantiles modeled as cubic splines (two linear parts joining at 40years). Percentiles were extrapolated and validated in an internal cohort of donors≥65years (n=147, France) and external cohort of donors and healthy subjects≥65years (n=329, Germany, Sweden, Norway, France, The Netherlands) by calculating percentages within the extrapolated 5th-95th percentile (P5-P95). Individuals in the development cohort had a higher mGFR (99.9±16.4 vs. 86.4±14 and 82.7±15.5mL/min/1.73m2) compared to the individuals in the validation cohorts. In the internal validation cohort, none (0%) had mGFR below the extrapolated P5, 12 (8.2%) above P95 and 135 (91.8%) between P5-P95. In the external validation cohort, five subjects had mGFR below the extrapolated P5 (1.5%), 25 above P95 (7.6%) and 299 (90.9%) between P5-P95. We demonstrate that extrapolation of mGFR from younger donors is possible and might aid with decision-making in elderly donors.

Pre- and postdonation kidney function in donors of a kidney paired donation with unique criteria for donor glomerular filtration rate - a longitudinal cohort analysis.

Baseline predonation estimated GFR (eGFR) appears to predict the risk of postdonation chronic kidney disease in live donors. New KIDGO guidelines recommend an eGFR ≥90 ml/min/1.73 m2 as an acceptable level of glomerular filtration rate (GFR) for kidney donation. In the Australian Paired Kidney Exchange (AKX) program, all donors with a raw measured GFR (mGFR) ≥80 ml/min are deemed suitable for donation, but the significance of this selection indicator is unclear. We analysed the first 129 live donors in the AKX program with at least 1-year follow-up linking records in the AKX database and ANZDATA. There were 73 male and 56 female donors; mean (±SD) age was 53 ± 11 years. Predonation eGFR was 94 ± 13 ml/min/1.73 m2 , mGFR 99 ± 17 ml/min/1.73 m2 and raw mGFR 108 ± 18 ml/min. Baseline eGFR was <80 ml/min/1.73 m2 in 19 donors, and <90 ml/min/1.73 m2 in 42 donors. At 1 year postdonation eGFR was 68 ± 15 ml/min/1.73 m2 and the predicted eGFR at 30 years postdonation was on average 50 (29-83) ml/min/1.73 m2 . The hypothetical mean age at end-stage kidney disease was estimated to be 145 (95% CI 120-263) years. Over 30% of AKX live donors would have been excluded from donation using KDIGO guidelines. Using AKX donor guidelines, the majority of donors with predicted eGFR <30 ml/min/1.73 m2 30-year postdonation were aged ≥50 years. Long-term outcome data on AKX donors with low eGFR will need careful monitoring.

Roles of Donor/Recipient Body Surface Area Ratio and Donor Kidney Glomerular Filtration Rate in Kidney Selection for Living Transplantation from Family Members

Accurate assessing donor renal function is crucial to the success of living kidney transplants. We studied the roles of donor kidney glomerular filtration rate (GFR) and donor/recipient body surface area (BSA) ratio in kidney selection for living transplantation from family members. We included 204 recipients who were subjected to living kidney transplantation from family members in our hospital from February 2011 to February 2015 and followed up for over 2 years. Recipients were divided into six groups according to donor GFR and donor/recipient BSA ratio. The effects of donor GFR or donor/recipient BSA ratio on the recovery of renal graft functions were evaluated. The post-operative serum creatinine (SCr) reduction rate, steady-state SCr level, and estimated GFR (eGFR) of the group with donor GFR ≥ 40 ml/min were slightly higher to those of the group with donor GFR < 40 ml/min (p > 0.05). The renal function recovery of the group with donor/recipient BSA ratio ≤ 0.8 was significantly lower than that of the group with donor/recipient BSA ratio ≥ 1.2 (p < 0.05). The post-operative SCr reduction rate, steady-state SCr level, and eGFR of the group with GFR < 40 ml/min and donor/recipient BSA ratio ≤ 0.8 were all significantly lower than those of the other five groups (P < 0.05). Such values of the two groups with donor/recipient BSA ratio >1.2 were significantly higher than those of the other four groups (p < 0.05). The selection of donor kidneys from relatives for living kidney transplantation should also consider donor/recipient BSA ratio in addition to donor GFR.

Correlation of the Glomerular Filtration Rate Measured With the Use of DTPA-Tc99m in Live Kidney Donors With Equations Based on Creatinine and Cystatin C

BackgroundRenal donation leads to a risk of developing chronic kidney disease, with an incidence of 0.47%. To evaluate for its presence, formulas based on serum creatinine are used, but up to 80% of these formulas underestimate the glomerular filtration rate (GFR) in donors. The aim of this work was to confirm the highest correlation of the GFR as measured with the use of DTPA-Tc99m with the GFR as estimated by means of the formula based on serum cystatin C (CKD-EPI creatinine–cystatin C) in healthy kidney donors. MethodsIn this observational, analytic, cross-sectional study, the GFR of kidney donors was determined ≥1 year after donation by means of DTPA gammagram and estimation with the use of conventional formulations and with cystatin C. ResultsOf 112 donors, 38 (34%) were included, 20 (60%) were female, with an overall average age of 40 years, 36.5 months after donation, and body mass index of 25.5 kg/m2. Correlation with the GFR as measured by means of DTPA gammagram was better with the use of CKD-EPI cystatin C (0.402; P = .020) and CKD-EPI creatinine-cystatin (0.549; P < .001) than the conventional formulas. Linear correlation with serum cystatin C was 0.825 (P < .001; 95% confidence interval, −105.3 to −63.2) for the CKD-EPI cystatin C formula, 0.77 (P < .001; −89.9 to −48.1) for the CKD-EPI creatinine-cystatin formula, and 0.525 (P = .002; −91.1 to −23.2) for DTPA-Tc99m scintigraphy. ConclusionsThere is a strong correlation between estimate the GFR by equations based on cystatin C and the measurement of the GFR by DTPA-Tc99m gammagram.

Tubular maximum phosphate reabsorption capacity in living kidney donors is independently associated with one-year recipient GFR

The donor glomerular filtration rate (GFR) measured before kidney donation is a strong determinant of recipient graft outcome. No tubular function markers have been identified that can similarly be used in donors to predict recipient outcomes. In the present study we investigated whether the pre-donation tubular maximum reabsorption capacity of phosphate (TmP-GFR), which may be considered a functional tubular marker in healthy kidney donors, is associated with recipient GFR at 1 yr after transplantation, a key determinant of long-term outcome. We calculated the pre-donation TmP-GFR from serum and 24-h urine phosphate and creatinine levels in 165 kidney donors, and recipient 125I-iothalamate GFR and eGFR (CKD-EPI) at 12 mo after transplantation. Kidney donors were 51 ± 10 yr old, 47% were men, and mean GFR was 118 ± 26 ml/min. The donor TmP-GFR was associated with recipient GFR 12 mo after transplantation (GFR 6.0 ml/min lower per 1 mg/dl decrement of TmP-GFR), which persisted after multivariable adjustment for donor age, sex, pre-donation GFR, and blood pressure and other potential confounders. Results were highly similar when eGFR at 12 mo was taken as the outcome. Tubular damage markers kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin were low and not associated with recipient GFR. A lower donor TmP-GFR before donation, which may be considered to represent a functional measure of tubular phosphate reabsorption capacity, is independently associated with a lower recipient GFR 1 yr after transplantation. These data are the first to link donor tubular phosphate reabsorption with recipient GFR post-transplantation.

Plasma Proenkephalin and Poor Long-Term Outcome in Renal Transplant Recipients.

Proenkephalin (pro-ENK), a stable and reliable surrogate marker for unstable enkephalins, was found to be associated with acute kidney injury and chronic renal failure in previous studies. We aimed to investigate whether pro-ENK is linked to chronic kidney injury and poor long-term outcome in renal transplant recipients (RTR). We included 664 stable RTR and 95 healthy kidney donors. Pro-ENK was measured in plasma with a double monoclonal sandwich immunoassay. Graft failure was defined as return to dialysis therapy or retransplantation. Median pro-ENK was 110 pmol/L (interquartile range [IQR], 85-148 pmol/L) in RTR and 48 pmol/L (IQR, 42-55 pmol/L) in kidney donors. Pro-ENK was correlated with estimated glomerular filtration rate (GFR) (rs = -0.80, P < 0.001) in RTR and with measured GFR (rs = -0.74, P < 0.001) in kidney donors. During a median follow-up of 3.1 years (IQR, 2.7-3.9 years), 45 RTR developed graft failure and 76 died. Pro-ENK was positively associated with risk (hazard ratio [HR] per standard deviation increment of the logarithm of pro-ENK; 95% confidence interval [CI]) of graft failure (HR, 4.80; 95% CI, 3.55-6.48) and mortality (HR, 1.50; 95% CI, 1.22-1.85). After adjustment of age, sex, and estimated GFR, the association of pro-ENK with graft failure remained significant (HR, 2.36; 95% CI, 1.37-4.06), whereas no significant association of pro-ENK with risk of all-cause mortality was observed (HR, 1.34; 95% CI, 0.90-2.09). Plasma pro-ENK is associated with kidney function as reflected by correlations with measured GFR in both RTR and kidney donors. In addition, pro-ENK was independently associated with increased risk of graft failure in RTR. Pro-ENK may aid in identification of RTR at risk for late graft failure.

Quantification of Single-Kidney Function and Volume in Living Kidney Donors Using Dynamic Contrast-Enhanced MRI.

The objective of our study was to investigate whether dynamic contrast-enhanced MRI (DCE-MRI) can detect differences and potential adaption in single-kidney parenchymal volume, blood flow, glomerular filtration rate (GFR), and filtration fraction in the remaining kidney of healthy donors compared with nondonors. Further, we evaluated the agreement in donor GFRs measured using DCE-MRI versus serum clearance of iohexol. Twenty living kidney donors and 20 healthy control subjects underwent DCE-MRI and iohexol GFR. Renal parenchymal volume was assessed from maximum-signal-intensity maps. Single-kidney MRI measurements of blood flow and GFR were derived from parenchymal signal intensity-time curves fitted to a two-compartment filtration model. The Student t test, Pearson correlation coefficient, mean differences, and limits of agreement were applied to analyze MRI measurements between groups and agreement with iohexol GFR. MRI findings showed significantly higher blood flow (difference in mean values of donors vs control subjects, 54%; p = 0.001), GFR (78%, p < 0.0001), and renal parenchymal volume (65%, p < 0.0001) in the single kidney of donors compared with the single kidney of healthy control subjects. In the donors, a proportional increase in blood flow and GFR resulted in a comparable filtration fraction, as was observed in the control subjects. Significant correlations were found between MRI-derived GFR and parenchymal volume (p < 0.0016) as well as with iohexol GFR (p < 0.0001). The mean difference between MRI-derived GFR and iohexol GFR was 14.0 mL/min, and the limits of agreement between MRI-derived GFR and iohexol GFR were -24.1 and 52.1 mL/min. DCE-MRI-derived values for single-kidney function and volume in kidney donors were significantly higher than those in control subjects and suggest a future potential benefit of DCE-MRI for diagnostic and prognostic structural and functional assessments in living kidney donors.

Immediate Impact of Uni-nephrectomy among Bangladeshi Healthy Live Kidney Donors: BIRDEM General Hospital Experience

Background: Kidney transplantation is the preferred treatment option for end stage kidney disease. Live kidney donation is an established form of organ donation; but it carries the risk of an unnecessary surgery in a normal individual. These donors remain at an increased risk of multiple medical problems for the rest of their life.Objective: In this study, we evaluated the immediate impact of uninephrectomy among kidney donors during the period of post-transplant hospital stay.Materials and Methods: This cross-sectional study was done at BIRDEM General Hospital from January 2006 to June 2014. All kidney donors who had undergone graft nephrectomy during the study period were the study population. All the donors underwent Tc-99m diethylene triamine pentaacetic acid (Tc-99m DTPA) renogram for measurement of glomerular filtration rate (GFR). GFR was also estimated by different equations in both pre-transplant and post-transplant periods. Pre-uninephrectomy GFR and post-uninephrectomy GFR of donors were compared.Results: Total number of subjects was 81, male 48 and female 33. Mean age was 36.3 ± 9.9 years. Mean postoperative hospital stay was 8.2 ± 2.0 days. The mean pre-operative measured glomerular filtration rate (mGFRDTPA) was 99.54 ± 19.06 mL/min/1.73 m2 and mean estimated glomerular filtration rate (eGFRCKD-EPI) was 99.0 ± 18.55 mL/min/1.73 m2 (p=0.855). In post-nephrectomy period mean urine output decreased from 2708.1 ± 842.8 to 2228.4 ± 702.4 mL/day (p=0.000). Mean SBP lowered from 120.3 ± 12.5 to 115.6 ± 9.2 mm of Hg (p=0.000) after nephrectomy. There was significant increase in blood urea (from 19.7 ± 5.7 to 30.4 ± 9.5 mg/dL, p=0.000) and serum creatinine (from 0.90 ± 0.16 to 1.26 ± 0.24 mg/dL, p=0.000) in post-uninephrectomy period. Mean mGFRDTPA of the subjects of non-nephrectomized kidney of the donors was 49.18 ± 9.50 mL/min/1.73 m2 and mean eGFRCKD-EPI of same kidneys was 69.09 ± 16.79 mL/min/1.73m2 (p=0.000) after uni-nephrectomy.Conclusion: Uninephrectomy in healthy adult kidney donors has immediate impacts on urine output, blood pressure, blood urea and serum creatinine levels.J Enam Med Col 2016; 6(2): 71-74

Cardiovascular Effects of Unilateral Nephrectomy in Living Kidney Donors.

There is a robust inverse graded association between glomerular filtration rate (GFR) and cardiovascular risk, but proof of causality is lacking. Emerging data suggest living kidney donation may be associated with increased cardiovascular mortality although the mechanisms are unclear. We hypothesized that the reduction in GFR in living kidney donors is associated with increased left ventricular mass, impaired left ventricular function, and increased aortic stiffness. This was a multicenter, parallel group, blinded end point study of living kidney donors and healthy controls (n=124), conducted from March 2011 to August 2014. The primary outcome was a change in left ventricular mass assessed by magnetic resonance imaging (baseline to 12 months). At 12 months, the decrease in isotopic GFR in donors was -30±12 mL/min/1.73m(2). In donors compared with controls, there were significant increases in left ventricular mass (+7±10 versus -3±8 g; P<0.001) and mass:volume ratio (+0.06±0.12 versus -0.01±0.09 g/mL; P<0.01), whereas aortic distensibility (-0.29±1.38 versus +0.28±0.79×10(-3) mm Hg(-1); P=0.03) and global circumferential strain decreased (-1.1±3.8 versus +0.4±2.4%; P=0.04). Donors had greater risks of developing detectable highly sensitive troponin T (odds ratio, 16.2 [95% confidence interval, 2.6-100.1]; P<0.01) and microalbuminuria (odds ratio, 3.8 [95% confidence interval, 1.1-12.8]; P=0.04). Serum uric acid, parathyroid hormone, fibroblast growth factor-23, and high-sensitivity C-reactive protein all increased significantly. There were no changes in ambulatory blood pressure. Change in GFR was independently associated with change in left ventricular mass (R(2)=0.28; P=0.01). These findings suggest that reduced GFR should be regarded as an independent causative cardiovascular risk factor. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01028703.