scholarly journals Creatinine-Based Estimations of Kidney Function Are Unreliable in Obese Kidney Donors

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Nidhi Aggarwal ◽  
Anna C. Porter ◽  
Ignatius Y. S. Tang ◽  
Bryan N. Becker ◽  
Sanjeev K. Akkina
Keyword(s):  
Creatinine Clearance ◽  
Kidney Function ◽  
Estimating Equations ◽  
Average Risk ◽  
Accurate Assessment ◽  
Kidney Donors ◽  
Disease Epidemiology ◽  
Living Kidney Donors ◽  
Donor Evaluation

Accurate assessment of kidney function by measurement of glomerular filtration rate (GFR) is essential to the risk assessment of prospective living kidney donors. We evaluated the performance of various estimating equations for creatinine clearance (Cockcroft-Gault), GFR (Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology Collaboration), and 24-hour urine collections for creatinine clearance in obese potential kidney donors. We evaluated 164 potential kidney donors including 49 with a BMI of 30–35 and 32 with a BMI >35 that have completed a routine living donor evaluation with a measured GFR. All the estimating equations performed poorly in obese donors. While 24-hour urine collections performed better, only 15% had an adequate 24-hour urine collection. Since obese kidney donors may be at higher than average risk for kidney failure, accurate assessment of kidney function in these donors is crucial to ensure their long-term health postdonation.

scholarly journals The evaluation of kidney function in living kidney donor candidates

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0003052021
Author(s):  
Neetika Garg ◽  
Emilio D. Poggio ◽  
Didier Mandelbrot
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Creatinine Clearance ◽  
Kidney Function ◽  
The United States ◽  
Estimated Gfr ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Increased Risk ◽  
Measured Gfr

Living kidney donors incur a small increased risk of end-stage kidney disease (ESKD), of which pre-donation glomerular filtration rate (GFR) is an important determinant. As a result, kidney function assessment is central to the donor candidate evaluation and selection process. This article reviews the different methods of GFR assessment including estimated GFR, creatinine clearance and measured GFR, and the current guidelines on GFR thresholds for donor acceptance. Estimated GFR obtained using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation, while the best of estimating estimations, tends to underestimate and has limited accuracy, especially near normal GFR values. In the United States, the Organ Procurement and Transplantation Network policy on living donation mandates either measured GFR or creatinine clearance as part of evaluation. Measured GFR is considered the gold standard, although there is some variation in performance characteristics depending on the marker and technique used. Major limitations of creatinine clearance are dependency on accuracy of timed collection, and overestimation as a result of distal tubular creatinine secretion. GFR declines with healthy aging, and most international guidelines recommend use of age-adapted selection criteria. The 2017 Kidney Disease: Improving Global Outcomes Guideline for the Evaluation and Care of Living Kidney Donors diverges from other guidelines and recommends using absolute cut-off of <60 ml/min/1.73m2 for exclusion and of ≥90 ml/min/1.73m2 for acceptance, and determination of candidacy with intermediate GFR based on long-term ESKD risk. However, several concerns for this strategy exist, including inappropriate acceptance of younger candidates due to underestimation of risk, and exclusion of older candidates whose kidney function is in fact appropriate for age. Role of cystatin C and other newer biomarkers, as well as data on impact of pre-donation GFR on not just ESKD risk but also advanced chronic kidney disease risk and cardiovascular outcomes are needed.

scholarly journals Long‐term Kidney Function and Survival in Recipients of Allografts from Living Kidney Donors with Hypertension: A National Cohort Study

2021 ◽  
Author(s):  
Fawaz Al Ammary ◽  
Sile Yu ◽  
Abimereki D. Muzaale ◽  
Dorry L. Segev ◽  
Luckmini Liyanage ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Function ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
National Cohort

Influence of the Kidney Histology at the Time of Donation on Long Term Kidney Function in Living Kidney Donors

2005 ◽  
Vol 37 (8) ◽  
pp. 3351-3353 ◽  
Author(s):  
H. Goecke ◽  
A.M. Ortiz ◽  
P. Troncoso ◽  
L. Martinez ◽  
A. Jara ◽  
...  
Keyword(s):  
Kidney Function ◽  
Kidney Donors ◽  
Living Kidney Donors

scholarly journals D-Serine mediates cellular proliferation for kidney remodeling

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0000832021
Author(s):  
Atsushi Hesaka ◽  
Yusuke Tsukamoto ◽  
Shigeyuki Nada ◽  
Masataka Kawamura ◽  
Naotsugu Ichimaru ◽  
...  
Keyword(s):  
Kidney Function ◽  
High Performance ◽  
Cellular Proliferation ◽  
Physiological Activity ◽  
Unilateral Nephrectomy ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Related Pathway ◽  
Remnant Kidney

Background: D-Serine, a long-term undetected enantiomer of serine, is a biomarker that reflects kidney function and disease activity. The physiological functions of D-serine have been unclear. Methods: Dynamics of D-serine was assessed by measuring D-serine in human samples of living kidney donors using two-dimensional high-performance liquid chromatography, and by auto-radiographic studies in mice. Effects of D-serine on kidney were examined by gene expression profiling and metabolic studies using unilateral nephrectomy mice, and genetically modified cells. Results: Unilateral nephrectomy in human living kidney donors decreases urinary excretion and thus increases the blood level of D-serine. D-Serine is quickly and dominantly distributed to the kidney upon injection in mice, suggesting that the kidney is a main target organ. Treatment of D-serine at low dose promotes the enlargement of remnant kidney in mouse model. Mechanistically, D-serine activates the cell cycle for tissue remodeling through an mTOR-related pathway. Conclusions: D-Serine is a physiological molecule that promotes kidney remodeling. Besides its function as a biomarker, D-serine has a physiological activity that influences kidney function.

scholarly journals Kidney Microstructural Features at the Time of Donation Predict Long-term Risk of Chronic Kidney Disease in Living Kidney Donors

2021 ◽  
Vol 96 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Massini A. Merzkani ◽  
Aleksandar Denic ◽  
Ramya Narasimhan ◽  
Camden L. Lopez ◽  
Joseph J. Larson ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Donors ◽  
Living Kidney Donors

scholarly journals Long-term risks after kidney donation: how do we inform potential donors? A survey from DESCARTES and EKITA transplantation working groups

2021 ◽  
Author(s):  
Geir Mjøen ◽  
Umberto Maggiore ◽  
Nicos Kessaris ◽  
Diederik Kimenai ◽  
Bruno Watschinger ◽  
...  
Keyword(s):  
Evaluation Process ◽  
Kidney Donation ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Relative Risks ◽  
Written Information ◽  
The Difference ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Publications from the last decade have increased knowledge regarding long-term risks after kidney donation. We wanted to perform a survey to assess how transplant professionals in Europe inform potential kidney donors regarding long-term risks. The objectives of the survey were to determine how they inform donors and to what extent, and to evaluate the degree of variation. Methods All transplant professionals involved in the evaluation process were considered eligible, regardless of the type of profession. The survey was dispatched as a link to a web-based survey. The subjects included questions on demographics, the information policy of the respondent and the use of risk calculators, including the difference of relative and absolute risks and how the respondents themselves understood these risks. Results The main finding was a large variation in how often different long-term risks were discussed with the potential donors, i.e. from always to never. Eighty percent of respondents stated that they always discuss the risk of end-stage renal disease, while 56% of respondents stated that they always discuss the risk of preeclampsia. Twenty percent of respondents answered correctly regarding the relationship between absolute and relative risks for rare outcomes. Conclusions The use of written information and checklists should be encouraged. This may improve standardization regarding the information provided to potential living kidney donors in Europe. There is a need for information and education among European transplant professionals regarding long-term risks after kidney donation and how to interpret and present these risks.

Long-term outcomes of kidney donors with fibromuscular dysplasia

2021 ◽  
Author(s):  
Horacio E Adrogue ◽  
Andrew Evans ◽  
Dina N Murad ◽  
Hana Nguyen ◽  
Sean A Hebert ◽  
...  
Keyword(s):  
Fibromuscular Dysplasia ◽  
Cox Regression ◽  
Arterial Disease ◽  
Similar Proportion ◽  
Long Term Outcomes ◽  
No Donor ◽  
Kidney Donors ◽  
Cox Regression Analysis ◽  
Donor Evaluation

Abstract Background Fibromuscular dysplasia (FMD) is a non-atherosclerotic systemic arterial disease that is not infrequently discovered during kidney donor evaluation. Current guidelines do not provide recommendations regarding the use of kidneys from donors with FMD and there is a paucity of data on the outcomes of these donors. Methods The Renal and Lung Living Donor Evaluation (RELIVE) study addressed long-term outcomes of 8922 kidney donors who donated between 1963 and 2007. We compared the development of hypertension, cardiovascular disease (CVD), proteinuria and reduced estimated glomerular filtration rate (eGFR) in 113 kidney donors with FMD discovered during donor evaluation versus 452 propensity score matched donors without FMD. Outcomes modeling with logistic and Cox regression analysis and Kaplan–Meier statistics were performed. Results Donors with FMD were older (51 versus 39 years), were more likely to be women (80% versus 56%) and had a higher systolic blood pressure at donation (124.7 versus 121.3 mmHg) (P &lt; 0.05 for all). After a mean ± standard deviation follow-up of 15.5 ± 8.9 years, a similar proportion of donors with and without FMD were alive, and developed hypertension (22.2% versus 19.8%), proteinuria (20.6% versus 13.7%) and CVD (13.3% versus 13.5%). No donor with FMD developed an eGFR &lt;30 mL/min/1.73 m2 or end-stage kidney disease. The multivariable risk of mortality, CVD and renal outcomes in donors with FMD was not elevated. Conclusions Kidney donors with FMD appear to do well, do not appear to incur increased risks of hypertension, proteinuria, CVD or reduced eGFR, and perhaps carefully selected candidates with FMD can safely donate as long as involvement of other vascular beds is ruled out.

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