Obesity has been associated with chronic kidney disease and its risk factors. Therefore, we hypothesized that weight increase post-donation would adversely affect kidney function, blood pressure, and metabolic risk factors in living kidney donors (LKD).

Methods: We studied 227 LKD and assessed BP changes and risk factors that are used to define metabolic syndrome in relation to change in weight (kg) and BMI from pre- to post-donation. Median time of follow up was 439 days (194–860 days).

Results: Increased body weight after donation was present in 112 (49.3%) donors. When compared to those who lost or maintained weight, donors with weight gain were more likely to have an increase in systolic blood pressure and triglycerides and a decrease in HDL-cholesterol levels (see Table). These changes were independent statistically in a multivariable model (p<.05 for all). Importantly, change in GFR and fasting glucose were not different between groups (-32.8±9.4 vs -31.8±9.6, p=0.441). These changes led to the new diagnosis of metabolic syndrome in 15.5% of the donors and reversal of metabolic syndrome in 9.1% (p=0.009).

To validate these results, we queried the SRTR database. Among 13,451 donors in the US (2004-2011), a weight gain of at least 5 kg by one year of follow up had a statistically significant positive association with an increased systolic (+2.6 mmHg, p<0.001) and diastolic blood pressures (+1.5 mmHg, p<0.001) in multivariable models adjusted for age, gender and race when compared to other donors.

Conclusions: Post-donation body weight changes are prevalent and associate with adverse changes in BP and lipids. Weight control is a modifiable risk factor which drives other metabolic abnormalities, hence the importance of emphasizing lifestyle modification behaviors in LKDs.

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