Living Kidney Donors Face Large Risk for CKD

[Zach]

Living Kidney Donors Face Large Risk for CKD
http://www.renalandurologynews.com/living-kidney-donors-face-large-risk-for-ckd/article/198730/

Jody A. CharnowMarch 19 2011

VIENNA—One year after undergoing living donor nephrectomy (LDN), more than half of donors will have chronic kidney disease (CKD), according to a British study. Their decline in renal function, however, appears to remain stable for at least five years and patients rarely suffer adverse cardiovascular events and cardiac mortality.

In the study, a team led by Nilay S. Patel, MD, a urology resident at The Churchill Hospital, examined data from 3,424 patients who underwent LDN in the United Kingdom and had preoperative and one-year follow-up data available. Complete post-operative follow-up data were available up to year 5 for 784 patients.

At one year, LDN was associated with an increase in mean serum creatinine level from 83 to 112 umol/L, Dr. Patel reported at the 26th Annual Congress of the European Association of Urology. This translated into a reduction in mean glomerular filtration rate (GFR) from 100 to 59 mL/min/1.73 m2. At one year, 53% of patients could be classified as having CKD stage 3-4. Mean GFR, however, did not change significantly between year 1 and year 5, said Dr. Patel, who presented study findings.

“The fall in GFR [following LDN] has been underestimated to date,” said Dr. Pitel, who noted that individuals wishing to donate a kidney will need to be informed of the latest data on renal function decline following LDN.

In patients with five years of follow-up, non-fatal cardiac events and cardiac mortality were reported in 0.4% and 0.05% of patients. New onset hypertension was diagnosed in 10% of subjects.

[Poppylicious]

I read this yesterday and it scared the bejesus out of me.  I shall put it to the back of my mind until my next appointment at the hospital, where I shall whip a printed copy out of my bag and demand reassurance from my living donor coordinator.

 

[MooseMom]

I'm skeptical.

[cariad]

I'm skeptical.

As am I.

50% had CKD within a year? Neither one of my donors has CKD, and we've known a few other live donors who are well past the one year mark.

I was told at my first eval in 2004 that at that point in time 52 donors had gone on to need transplants themselves, out of the tens of thousands that have ever donated in the US.

I believe there is a real risk that the donors are taking on, but to say 50% have stage 3 or 4 CKD by one year sounds like someone is pushing some political agenda, whatever that might be. Because only the healthiest people are allowed to donate, they used to say that donors as a group outlived the general population by a small margin.

[WishIKnew]

Wow!  Really!  This makes me not want to encourage anyone to be a living donor!

[MooseMom]

I think if you have a kidney removed, it is only logical to assume that your GFR is going to decrease.  But I am not sure that that translates into having kidney DISEASE.  Someone who had kidney DISEASE has an GREATLY INCREASED risk of cardiovascular problems, but as this "study" pointed out, this increased risk is not seen in healthy donors.

That study contradicts this one...

General News
Live Kidney Donors Experience GFR Increases
Rosemary Frei, MScMarch 14, 2011     
 
VANCOUVER, British Columbia—A Swedish study has confirmed that people who donate kidneys experience an increase in glomerular filtration rate (GFR) for more than a decade after nephrectomy.

The investigators determined that the average estimated GFR (eGFR) among donors who are 30 years old increases for 17 years then gradually declines. Similarly, 50-year-old donors will experience an increase in eGFR for 15 years followed by an annual drop of 1 mL/min/1.73 m2.

“The latter finding, in particular, is quite remarkable when you consider that the normal progression of renal function in a 50-year-old is an annual decrease of 1 mL/minute/1.73 m2, lead investigator John M. Söfteland, MD, a transplant surgeon at the Sahlgrenska University Hospital in Gothenburg, said after presenting these results at the XIII International Congress of The Transplantation Society. “Our data show that this group does experience this decrease in renal function, but only after they reach 65 years of age.”

Dr. Söfteland's team collected data from 823 kidney donors, 688 of whom answered the investigators' questionnaire and 573 of whom agreed to allow their current renal function to be measured. Among the latter, all 573 had their eGFR determined and 183 had their mGFR determined. They individuals had donated kidneys between 1965 and 2005, and the data collection occurred between 2007 and 2009.

The 573 subjects' mean age at donation was 47 years and their mean time since donation was 14.9 years. At the time Dr. Söfteland's team conducted their study the subjects' mean eGFR was 70.6 mL/min/1.73 m2 and their average measured GFR (mGFR) was 67.9 mL/min/1.73 m2.

The patients' eGFR and mGFR both decreased with age. The team's statistician then performed detailed statistical analyses to arrive at the curves for eGFR and mGFR over time for patients of two arbitrarily chosen ages at donation, 30 and 50 years. The results indicated that the median eGFR in a 30-year-old donor increases for 17 years following nephrectomy and then remains constant for eight years before slowly declining. Fifty-year-old donors enjoy an eGFR increase for 15 years before the gradual fall begins. Dr. Söfteland pointed out that there were more donors in the study who were closer to 30 years of age at donation than 50, and hence the result for the younger patients may be more robust.

Commenting on the findings, Paul Keown, MD, Director of Immunology at the University of British Columbia in Vancouver, called the research by Dr. Söfteland's group a “nice, large cohort study” that confirms the findings of a larger study published by a group at the University of Minnesota in Minneapolis (N Engl J Med. 2009;360:459-469).

“This is a very good estimate of what we anticipate to happen after kidney donation,” Dr. Keown said. “It has the usual shortcomings of any retrospective observational study, but I think in general it confirms our understanding that donors do well.”

[LivingDonorUK]

Hi there,
I am Diane and I am a living kidney donor from the UK where that article originated. I run a blog etc on Living donation and also support people who are donating and as such have had a few people contact me in a bit of a panic over that article. So I contacted the NHSBT (National Health Service Blood and Transplant) to ask if someone could give me an explanation of the article.  They telephoned me and said to reassure people about the article and that it was rather alarmist.  She is going to get an explanation for me that I can quote from but she also felt it might be appropriate to give better explanation of gfr and egfr etc etc in their own documentation. So it wont be until around end April that she can give me a written explanation that I can quote from.  When she does I will post back with it. In the meantime, she said to reassure people that there is nothing to be concerned about.

All the best
Di