Impact of Glomerular Filtration Rate Normalization to Body Surface Area on Donor Selection and Outcome in over 4000 Living Kidney Donors
1U of MN, Minneapolis
2Houston Methodist, Houston.
Meeting: 2018 American Transplant Congress
Abstract number: D143
Keywords: Donation, Glomerular filtration rate (GFR), Kidney
Session Information
Session Name: Poster Session D: Kidney Donor Selection / Management Issues
Session Type: Poster Session
Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Introduction: A donor GFR of ≥ 80 mL/min is a selection criterion. KDIGO recommends that GFR indexed to BSA should be used. Herein, we tested the implications of such policy on donor exclusion and compared long term outcomes of 4029 donors according to raw vs.normalized eGFR.
Methods: CKD-EPI creatinine equation was used to estimate normalized and raw (GFR). Multivariate Cox proportional hazards models were used to assess outcomes of interest using both GFR measures. Harrell's bias-adjusted C-index was used to measure discrimination. To assess the models calibration and goodness of fit, we used Gronnesby-Borgan test.
Results: 157 (3.89%) donors had normalized GFR of >80 mL/min/1.73m2 but <80 mL/min raw GFR with mean BSA 1.57 m2. In contrast, 368 (9.13%) donors had raw GFR >80 mL/min and normalized GFR <80 mL/min/1.73m2 with mean BSA 2.05 m2. Unlike other groups, women over represented the normalized only group at 95.5%.
| Both Criteria N=2965 | Normalized Only N=157 | Raw Only N=368 | Neither Criteria N=539 | |
| Donation creatinine mg/dL mean (SD) | 0.86 (0.14) | 0.87 (0.09) | 1.08 (0.14) | 1.02 (0.15) |
| CKD-EPI eGFR mL/min/1.73m2 | 100.0 (12.5) | 84.6 (3.63) | 75.2 (3.62) | 69.4 (7.04) |
| CKD-EPI eGFR mL/min | 109 (17.3) | 76.4 (2.62) | 88.8 (6.58) | 69.7 (7.42) |
| BSA mean (SD) | 1.88 (0.22) | 1.57 (0.08) | 2.05 (0.16) | 1.74 (0.14) |
| Age at Donation | 37.4 (11.0) | 41.5 (12.2) | 45.3 (10.3) | 47.8 (11.1) |
| Female | 1587 (53.5%) | 150 (95.5%) | 132 (35.9%) | 461 (85.5%) |
| Race White | 2781 (93.8%) | 148 (94.3%) | 359 (97.6%) | 532 (98.7%) |
| Smoking | 936 (31.7%) | 37 (23.9%) | 79 (21.7%) | 126 (23.8%) |
| BMI | 25.9 (4.28) | 21.9 (2.64) | 28.5 (3.92) | 24.9 (3.68) |
| Related | 2303 (77.7%) | 129 (82.2%) | 283 (76.9%) | 423 (78.5%) |
There was no difference in discrimination and calibration between the two measures in predicting mortality, development of diabetes, hypertension, proteinuria and ESRD in multivariate models.
Conclusion: normalizing GFR to BSA of 1.73 m2 may lead to accepting smaller donors who are typically women with lower GFR and denying larger donors with higher GFR. GFR normalization to BSA of 1.73m2should be reevaluated.
CITATION INFORMATION: Riad S., Keys D., Vock D., Jackson S., Berglund D., Vakil V., Matas A., Ibrahim H. Impact of Glomerular Filtration Rate Normalization to Body Surface Area on Donor Selection and Outcome in over 4000 Living Kidney Donors Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Riad S, Keys D, Vock D, Jackson S, Berglund D, Vakil V, Matas A, Ibrahim H. Impact of Glomerular Filtration Rate Normalization to Body Surface Area on Donor Selection and Outcome in over 4000 Living Kidney Donors [abstract]. https://atcmeetingabstracts.com/abstract/impact-of-glomerular-filtration-rate-normalization-to-body-surface-area-on-donor-selection-and-outcome-in-over-4000-living-kidney-donors/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress