Association of Pre- and Post-Donation Renal Function with Midterm Estimated Glomerular Filtration Rate in Living Kidney Donors: A Retrospective Study

• Published in: Yonsei medical journal Vol. 64; no. 3; pp. 221 - 227
• Main Authors: Park, Jin Ha, Kim, So Yeon, Cho, Jin Sun, Shin, Dongkwan, Ham, Sung Yeon, Kim, Hyesu, Kwak, Young-Lan
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.03.2023; 연세대학교의과대학
• Subjects: Creatinine; Glomerular Filtration Rate; Humans; Hypertension; Kidney - physiology; Kidney - surgery; Kidney Transplantation - adverse effects; Living Donors; Nephrectomy - adverse effects; Original; Retrospective Studies; 의학일반; Creatinine; eGFR at 6 months after donation; estimated glomerular filtration rate; outcome; living donor nephrectomy
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2022.0541

The estimated glomerular filtration rate (eGFR) at 6 months after donation (eGFR ) is strongly associated with the risk of end-stage renal disease in living kidney donors. This study aimed to investigate the incidence of eGFR <60 mL/min/1.73 m² (eGFR <60) and identify the risk factors that can predict the occurrence of eGFR <60 in living kidney donors. Living kidney donors who underwent nephrectomy at Severance Hospital between January 2009 and December 2019 were identified. We excluded 94 of 1233 donors whose creatinine values at 6 months after donation were missing. The risk factors for eGFR <60 were assessed using multivariate regression analysis. The optimal cutoff points for candidate risk factors for predicting eGFR <60 occurrence were determined using the Youden index. The eGFR <60 occurred in 17.3% of the participants. Older age (≥44 years), history of hypertension, lower preoperative eGFR (<101 mL/min/1.73 m²), and degree of increase in creatinine levels on postoperative day 2 compared to those before surgery (ΔCr2_pre) (≥0.39 mg/dL) increased the risk of eGFR <60. The addition of ΔCr2_pre to preoperative eGFR yielded a higher predictive accuracy for predicting eGFR <60 than that with preoperative eGFR alone {area under the receiver operating characteristic curve=0.886 [95% confidence interval (CI), 0.863-0.908] vs. 0.862 (95% CI, 0.838-0.887), <0.001}. The incidence of eGFR <60 was 17.3%. Older age, lower preoperative eGFR, history of hypertension, and greater ΔCr2_pre were associated with the occurrence of eGFR <60 after living donor nephrectomy. The combination of preoperative eGFR and ΔCr2_pre showed the highest predictive power for eGFR <60.