Creatinine-Based Equations Predicting Chronic Kidney Disease After Kidney Donation

• Published in: Transplantation proceedings Vol. 43; no. 7; pp. 2481 - 2486
• Main Authors: Libório, A.B, Barros, R.M, Esmeraldo, R.M, Oliveira, M.L.M.B, Silva, G.B, Daher, E.F
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.09.2011; Elsevier
• Subjects: Adult; Biological and medical sciences; Creatinine - urine; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - urine; Kidneys; Living Donors; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Predictive Value of Tests; ROC Curve; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Urinary system involvement in other diseases. Miscellaneous; Kidney disease; Creatinine; Urinary system disease; Equation; Chronic kidney disease; Transplantation; Kidney; Medicine; Treatment; Urinary system; Surgery; Renal failure; Graft
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2011.04.009

Abstract Background Kidney donation is associated with few adverse outcomes in living donors. The aim of this study was to evaluate the outcomes of living kidney donors and the utility of creatinine-based equations to predict chronic kidney disease. Methods The study population was selected among 154 living kidney donors from 2001 to 2009. Seventy-eight patients underwent medical consultation to review demographic data and perform laboratory evaluations. Estimated glomerular filtration rate (GFR) values were obtained by three equations: Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault (C-G) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Receiver operating characteristic (ROC) analysis was performed to determine the area under the curve of each equation to predict evolution to chronic kidney disease. Results The overall median age was 39 years including 64% of women subjects. The mean follow-up after kidney donation was 65 ± 34 months. During follow-up, 20.5% of patients developed hypertension. Serum creatinine values above 1.5 mg/dL were detected in 14.1% of cases. Dyslipidemia was present in 33.3% of donors at the last follow-up. According to measured creatinine clearance and the C-G equation, only four and six donors had renal failure (defined as GFR < 60 mL/min), a number that increased to 23 (29.4%) when considering the MDRD or CKD-EPI equations ( P < .05). ROC curves performed to explore the GFR measurements to predict renal failure occurrence after donation showed the CKD-EPI to be the only one with a significant area under the curve (0.7442, P = .003). Conclusion Living kidney donors should receive careful long-term follow-up. Assessment of renal function before donation using CKD-EPI creatinine-based equations must be performed preferentially. A careful approach should be adopted for the detection and treatment of other complications such as hypertension and dyslipidemia.