Bertram L Kasiske1, Teresa Anderson-Haag2, Ajay K Israni2, Roberto S Kalil3, Paul L Kimmel4, Edward S Kraus5, Rajiv Kumar6, Andrew A Posselt7, Todd E Pesavento8, Hamid Rabb5, Michael W Steffes9, Jon J Snyder10, Matthew R Weir11. 1. Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN. Electronic address: bkasiske@cdrg.org. 2. Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN. 3. Department of Medicine, University of Iowa, Iowa City, IA. 4. Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. 5. Department of Medicine, Johns Hopkins University, Baltimore, MD. 6. Department of Medicine, Mayo Clinic, Rochester, MN. 7. Department of Surgery, University of California at San Francisco, San Francisco, CA. 8. Department of Medicine, Ohio State University, Columbus, OH. 9. Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN. 10. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN. 11. Division of Nephrology, Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD.
Abstract
BACKGROUND: There have been few prospective controlled studies of kidney donors. Understanding the pathophysiologic effects of kidney donation is important for judging donor safety and improving our understanding of the consequences of reduced kidney function in chronic kidney disease. STUDY DESIGN: Prospective, controlled, observational cohort study. SETTING & PARTICIPANTS: 3-year follow-up of kidney donors and paired controls suitable for donation at their donor's center. PREDICTOR: Kidney donation. OUTCOMES: Medical history, vital signs, glomerular filtration rate, and other measurements at 6, 12, 24, and 36 months after donation. RESULTS: At 36 months, 182 of 203 (89.7%) original donors and 173 of 201 (86.1%) original controls continue to participate in follow-up visits. The linear slope of the glomerular filtration rate measured by plasma iohexol clearance declined 0.36±7.55mL/min per year in 194 controls, but increased 1.47±5.02mL/min per year in 198 donors (P=0.005) between 6 and 36 months. Blood pressure was not different between donors and controls at any visit, and at 36 months, all 24-hour ambulatory blood pressure parameters were similar in 126 controls and 135 donors (mean systolic blood pressure, 120.0±11.2 [SD] vs 120.7±9.7mmHg [P=0.6]; mean diastolic blood pressure, 73.4±7.0 vs 74.5±6.5mmHg [P=0.2]). Mean arterial pressure nocturnal dipping was manifest in 11.2% ± 6.6% of controls and 11.3% ± 6.1% of donors (P=0.9). Urinary protein-creatinine and albumin-creatinine ratios were not increased in donors compared with controls. From 6 to 36 months postdonation, serum parathyroid hormone, uric acid, homocysteine, and potassium levels were higher, whereas hemoglobin levels were lower, in donors compared with controls. LIMITATIONS: Possible bias resulting from an inability to select controls screened to be as healthy as donors, short follow-up duration, and dropouts. CONCLUSIONS: Kidney donors manifest several of the findings of mild chronic kidney disease. However, at 36 months after donation, kidney function continues to improve in donors, whereas controls have expected age-related declines in function.
BACKGROUND: There have been few prospective controlled studies of kidney donors. Understanding the pathophysiologic effects of kidney donation is important for judging donor safety and improving our understanding of the consequences of reduced kidney function in chronic kidney disease. STUDY DESIGN: Prospective, controlled, observational cohort study. SETTING & PARTICIPANTS: 3-year follow-up of kidney donors and paired controls suitable for donation at their donor's center. PREDICTOR: Kidney donation. OUTCOMES: Medical history, vital signs, glomerular filtration rate, and other measurements at 6, 12, 24, and 36 months after donation. RESULTS: At 36 months, 182 of 203 (89.7%) original donors and 173 of 201 (86.1%) original controls continue to participate in follow-up visits. The linear slope of the glomerular filtration rate measured by plasma iohexol clearance declined 0.36±7.55mL/min per year in 194 controls, but increased 1.47±5.02mL/min per year in 198 donors (P=0.005) between 6 and 36 months. Blood pressure was not different between donors and controls at any visit, and at 36 months, all 24-hour ambulatory blood pressure parameters were similar in 126 controls and 135 donors (mean systolic blood pressure, 120.0±11.2 [SD] vs 120.7±9.7mmHg [P=0.6]; mean diastolic blood pressure, 73.4±7.0 vs 74.5±6.5mmHg [P=0.2]). Mean arterial pressure nocturnal dipping was manifest in 11.2% ± 6.6% of controls and 11.3% ± 6.1% of donors (P=0.9). Urinary protein-creatinine and albumin-creatinine ratios were not increased in donors compared with controls. From 6 to 36 months postdonation, serum parathyroid hormone, uric acid, homocysteine, and potassium levels were higher, whereas hemoglobin levels were lower, in donors compared with controls. LIMITATIONS: Possible bias resulting from an inability to select controls screened to be as healthy as donors, short follow-up duration, and dropouts. CONCLUSIONS: Kidney donors manifest several of the findings of mild chronic kidney disease. However, at 36 months after donation, kidney function continues to improve in donors, whereas controls have expected age-related declines in function.
Authors: Ann Young; Immaculate F P Nevis; Colin Geddes; John Gill; Neil Boudville; Leroy Storsley; Amit X Garg Journal: Nephron Clin Pract Date: 2007-09-21
Authors: Neil Boudville; G V Ramesh Prasad; Greg Knoll; Norman Muirhead; Heather Thiessen-Philbrook; Robert C Yang; M Patricia Rosas-Arellano; Abdulrahman Housawi; Amit X Garg Journal: Ann Intern Med Date: 2006-08-01 Impact factor: 25.391
Authors: A X Garg; N Muirhead; G Knoll; R C Yang; G V R Prasad; H Thiessen-Philbrook; M P Rosas-Arellano; A Housawi; N Boudville Journal: Kidney Int Date: 2006-09-27 Impact factor: 10.612
Authors: Rudolf P Obermayr; Christian Temml; Maarten Knechtelsdorfer; Georg Gutjahr; Josef Kletzmayr; Susanne Heiss; Anton Ponholzer; Stephan Madersbacher; Rainer Oberbauer; Renate Klauser-Braun Journal: Nephrol Dial Transplant Date: 2007-11-26 Impact factor: 5.992
Authors: Daniel E Weiner; Hocine Tighiouart; Essam F Elsayed; John L Griffith; Deeb N Salem; Andrew S Levey Journal: J Am Soc Nephrol Date: 2008-03-12 Impact factor: 10.121
Authors: Meg J Jardine; Amy Kang; Sophia Zoungas; Sankar D Navaneethan; Toshiharu Ninomiya; Sagar U Nigwekar; Martin P Gallagher; Alan Cass; Giovanni Strippoli; Vlado Perkovic Journal: BMJ Date: 2012-06-13
Authors: Naim Issa; Lisa E Vaughan; Aleksandar Denic; Walter K Kremers; Harini A Chakkera; Walter D Park; Arthur J Matas; Sandra J Taler; Mark D Stegall; Joshua J Augustine; Andrew D Rule Journal: Am J Transplant Date: 2019-02-01 Impact factor: 8.086
Authors: Courtenay M Holscher; Christine E Haugen; Kyle R Jackson; Jacqueline M Garonzik Wang; Madeleine M Waldram; Sunjae Bae; Jayme E Locke; Rhiannon D Reed; Krista L Lentine; Gaurav Gupta; Matthew R Weir; John J Friedewald; Jennifer Verbesey; Matthew Cooper; Dorry L Segev; Allan B Massie Journal: Clin J Am Soc Nephrol Date: 2019-09-19 Impact factor: 8.237