Living kidney donors have become of great importance to kidney transplantation. Obviously, living kidney donation is only justified if long-term donor safety is guaranteed. Many kidney donors have an estimated GFR<60 mL/min/1.73m early post-donation and thus meet with criteria of chronic kidney disease stage 3 (CKD3). However, the prognosis of a low GFR with one healthy kidney may not be equivalent to the prognosis of the same GFR with two diseased kidneys. To test this hypothesis, we compared long-term kidney function course of post-donation kidney donors and CKD patients.
Material & methods:
We included 57 post-donation kidney donors and 57 CKD patients, who were matched for age, gender, GFR, and time of follow-up. Both had gold standard GFR measurements with 125I-iothalamate, blood pressure measurements, and assessment of proteinuria at baseline and during follow-up. Kidney function slope was calculated as (GFR follow-up – baseline GFR)/duration of follow-up, giving a slope in ml/min/year.
Mean age was 48±11 years in donors and 48±12 years in CKD patients, both groups were 63% male. At baseline, donors and CKD patients had similar kidney function, with GFR of 67±11 ml/min vs. 71±18 ml/min (p=NS). 25% of donors and 26% of CKD patients met criteria for CKD3. Both groups were followed for 4.7±1.5 years. At follow-up, donors had significantly better kidney function than CKD patients, with GFR of 73±12 ml/min vs. 63±21 ml/min (p<0.01). In all donors GFR increased over time, while GFR fell in all CKD patients, with a slope of +1.8±1.6 ml/min/year in donors vs. -1.4±3.4 ml/min/year in CKD patients (p<0.01). CKD stage improved to CKD 0-2 in 13 donors with CKD3 at baseline, whereas it worsened in 21 CKD patients.
Despite similar baseline GFR and CKD stage, former kidney donors show a substantially different course in kidney function than CKD patients. Even though many kidney donors have a low GFR early post-donation, these healthy individuals should not be regarded as CKD patients. CKD criteria are not suitable for former kidney donors.
To cite this abstract in AMA style:de L, Tent H, Sanders J, Hofker S, Bakker S, Navis G. Low GFR after Kidney Donation Is Not Chronic Kidney Disease [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/low-gfr-after-kidney-donation-is-not-chronic-kidney-disease/. Accessed November 22, 2017.
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