How Do Living Kidney Donors Develop End-Stage Renal Disease?

American Journal of Transplantation
Volume 9 Issue 11, Pages 2514 - 2519

How Do Living Kidney Donors Develop End-Stage Renal Disease?
R. Kido a,*, Y. Shibagaki b , K. Iwadoh c , I. Nakajima c , S. Fuchinoue c , T. Fujita a and S. Teraoka c
a Department of Nephrology and Endocrinology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan b Division of Nephrology and Hypertension, School of Medicine, St. Marianna University, Kanagawa, Japan c Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
* Corresponding author: Ryo Kido, Ryo.kido@mb5.seikyou.ne.jp

ABSTRACT

The clinical course and risk factors for developing end-stage renal disease (ESRD) after heminephrectomy in living kidney donors have scarcely been investigated. We reviewed medical records and identified eight case donors who developed chronic kidney disease (CKD) stage 5 or ESRD, and subsequently investigated the association between postoperative clinical courses and changes in renal function. To conduct a case-control study, we also selected a control group comprising 24 donors who had maintained stable renal function and were matched for age, sex and follow-up time since donation. Except for one donor who developed ESRD caused by a traffic accident, none of the donors developed progressive renal dysfunction immediately after donation. Their renal functions remained stable for a long period of time, but started to decline after developing new comorbidities, especially risk factors known as progression factors (proteinuria or hypertension) or accelerating factors (cardiovascular event or infection) of CKD. As compared with the control donors, incidence of postoperative persistent proteinuria, acute CV event, severe infection and hospitalization due to accelerating factors of CKD were significantly higher in the case donors. These results suggest the importance of long-term (more than 10 years) follow-up of donors with special attention on the risk factors of CKD.

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1600-6143.2009.02795.x

http://www3.interscience.wiley.com/journal/122547176/abstract