Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Current definitions of chronic kidney disease (CKD) staging define any individual with eGFR<60 as having stage 3 or higher CKD. Nearly half of living kidney donors (LKDs) have post-donation eGFR below this threshold, but the clinical interpretation of eGFR<60 in donors is unknown, and the "CKD" label may not be appropriate. Evidence of risk associated with decreased post-donation eGFR is needed to inform international guidelines and best practices for donor followup and care management.
METHODS: Using SRTR data, we studied end-stage renal disease (ESRD) risk in 67,571 LKDs 1999-2015 with at least one reported postdonation serum creatinine (SCr). eGFR was calculated via the CKD-EPI equation. Measurements with eGFR<15 were excluded from analysis. We modeled the association between eGFR category (≥60, 45-59, 30-44, 15-30, corresponding to no CKD, CKD stage 3, stage 4A, and stage 4B) using Cox regression with eGFR category as a time-varying exposure and adjusting for donor age, sex, race (black vs nonblack), BMI, and 1st-degree biological relationship to recipient.
RESULTS: 117,051 CKD measurements were reported at median (IQR) 11 (4-14) months post-donation (90th percentile 25m post-donation). Of these, 33.9% were in the range 45-59, 5.7% were in the range 30-45, and 0.8% were in the range 15-29. In an unadjusted model, eGFR 30-45 was associated with 3.9-fold higher risk of ESRD compared to donors with eGFR≥60 (HR=1.80 3.94 8.60, p<0.01) and eGFR 15-29 was associated with 40-fold higher risk (HR=5.41 40.29 299.77, p<0.001) (Table). After adjustment, these associations persisted with 5.3-fold higher risk for eGFR 30-45 and 54-fold higher risk for eGFR 15-29 (both p<0.001, Table). Donors with eGFR 45-60 had elevated risk but the association was not statistically significant (unadjusted HR=0.81 1.50 2.79, p=0.2; aHR=0.92 1.86 3.77, p=0.08).
CONCLUSIONS: The categorization of eGFR 45-60 as "CKD stage 3" may not be clinically meaningful among LKDs. Nevertheless, eGFR category is associated with ESRD risk among donors with eGFR<30, and our results support current guidelines recommending longitudinal followup of renal function in living kidney donors.
CITATION INFORMATION: Massie A., Henderson M., Al Ammary F., Snyder J., Segev D. Clinical Utility and Interpretation of CKD Stages in Living Kidney Donors Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Massie A, Henderson M, Ammary FAl, Snyder J, Segev D. Clinical Utility and Interpretation of CKD Stages in Living Kidney Donors [abstract]. https://atcmeetingabstracts.com/abstract/clinical-utility-and-interpretation-of-ckd-stages-in-living-kidney-donors/. Accessed June 3, 2020.
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