A Prospective Controlled Study of Living Kidney Donors: Three-Year Follow-up

Kasiske, Bertram L.; Anderson-Haag, Teresa; Israni, Ajay K.; Kalil, Roberto; Kimmel, Paul L.; Kraus, Edward S.; Kumar, Rajiv; Posselt, Andrew A.; Pesavento, Todd E.; Rabb, Hamid; Steffes, Michael W.; Snyder, Jon J.; Weir, Matthew R.

doi:10.1053/j.ajkd.2015.01.019

Cited by 150 publications

(138 citation statements)

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“…We found 9 studies, 6–14 not including the current study 15, 16 reporting possible mineral and bone disorders in kidney donors (Table S1). Of the previous 9 studies, 5 were prospective, comparing changes before and after donation but did not include normal controls.…”

Section: Discussionmentioning

confidence: 99%

“…16 Despite reduced levels of serum phosphate, tubular resorption of phosphate declined (Table 3), indicating that renal phosphate excretion was the likely cause, or at least a contributing factor to the lower serum phosphate concentrations. Although 3 studies reported no change in serum phosphate concentrations, 6, 10, 14 3 others reported a decline in phosphate after kidney donation.…”

Section: Discussionmentioning

confidence: 99%

“…15, 16 Consecutive kidney donors at each study site were asked to participate prior to donation. For donors that consented to participate, a control was found that would have been a suitable donor at the same site as the donor.…”

Section: Methodsmentioning

confidence: 99%

“…When more than one potential control was available, preference was given to age and sex to match the donor as closely as possible; 182 of 203 (89.7%) original donors and 173 of 201 (86.1%) original controls completed the 36 month follow-up visits. 16 …”

Section: Methodsmentioning

confidence: 99%

“…15, 16 We previously reported that for up to 3 years after donation, serum PTH concentrations were elevated in donors compared to pre-donation values and compared to controls. 16 Because of these observations, and previous reports of elevated PTH and FGF23 concentrations among donors, we measured serum concentrations of intact PTH, intact FGF23, 25-hydroxyvitamin D, 1,25(OH) 2 D 3 , the tubular reabsorption of calcium and phosphorus, and markers of bone resorption and formation in donors and controls. The results show that 3 years after kidney donation, donors have increased PTH, FGF23 and reduced 1,25(OH) 2 D 3 concentrations, and concomitant increases in serum markers of bone resorption, which if persistent could place donors at risk of increased bone loss in future years.…”

Section: Introductionmentioning

confidence: 97%

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Abnormalities in biomarkers of mineral and bone metabolism in kidney donors

Kasiske

Kumar

Kimmel

et al. 2016

Kidney International

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Previous studies have suggested that kidney donors may have abnormalities of mineral and bone metabolism typically seen in chronic kidney disease. This may have important implications for the skeletal health of living kidney donors and for our understanding of the pathogenesis of long term mineral and bone disorders in chronic kidney disease. In this prospective study, 182 of 203 kidney donors and 173 of 201 paired normal controls had markers of mineral and bone metabolism measured before and at 6 and 36 months after donation (ALTOLD Study). Donors had significantly higher serum concentrations of intact parathyroid hormone (24.6% and 19.5%) and fibroblast growth factor-23 (9.5% and 8.4%) at 6 and 36 months, respectively, as compared to healthy controls, and significantly reduced tubular phosphate reabsorption (−7.0% and −5.0%) and serum phosphate concentrations (−6.4% and −2.3%). Serum 1,25-dihydroxyvitamin D3 concentrations were significantly lower (−17.1% and −12.6%), while 25-hydroxyvitamin D (21.4% and 19.4%,) concentrations were significantly higher in donors compared to controls. Moreover, significantly higher concentrations of the bone resorption markers, carboxyterminal cross-linking telopeptide of bone collagen (30.1% and 13.8%) and aminoterminal cross-linking telopeptide of bone collagen (14.2% and 13.0%), and the bone formation markers, osteocalcin (26.3% and 2.7%), and procollagen type I N-terminal propetide (24.3% and 8.9%) were observed in donors. Thus, kidney donation alters serum markers of bone metabolism that could reflect impaired bone health. Additional long term studies that include assessment of skeletal architecture and integrity are warranted in kidney donors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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Abnormalities in biomarkers of mineral and bone metabolism in kidney donors

Kasiske

Kumar

Kimmel

et al. 2016

Kidney International

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Hypertension and Kidney Function After Living Kidney Donation

Garg,

Arnold,

Cuerden

et al. 2024

JAMA

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ImportanceRecent guidelines call for better evidence on health outcomes after living kidney donation.ObjectiveTo determine the risk of hypertension in normotensive adults who donated a kidney compared with nondonors of similar baseline health. Their rates of estimated glomerular filtration rate (eGFR) decline and risk of albuminuria were also compared.Design, Setting, and ParticipantsProspective cohort study of 924 standard-criteria living kidney donors enrolled before surgery and a concurrent sample of 396 nondonors. Recruitment occurred from 2004 to 2014 from 17 transplant centers (12 in Canada and 5 in Australia); follow-up occurred until November 2021. Donors and nondonors had the same annual schedule of follow-up assessments. Inverse probability of treatment weighting on a propensity score was used to balance donors and nondonors on baseline characteristics.ExposureLiving kidney donation.Main Outcomes and MeasuresHypertension (systolic blood pressure [SBP] ≥140 mm Hg, diastolic blood pressure [DBP] ≥90 mm Hg, or antihypertensive medication), annualized change in eGFR (starting 12 months after donation/simulated donation date in nondonors), and albuminuria (albumin to creatinine ratio ≥3 mg/mmol [≥30 mg/g]).ResultsAmong the 924 donors, 66% were female; they had a mean age of 47 years and a mean eGFR of 100 mL/min/1.73 m2. Donors were more likely than nondonors to have a family history of kidney failure (464/922 [50%] vs 89/394 [23%], respectively). After statistical weighting, the sample of nondonors increased to 928 and baseline characteristics were similar between the 2 groups. During a median follow-up of 7.3 years (IQR, 6.0-9.0), in weighted analysis, hypertension occurred in 161 of 924 donors (17%) and 158 of 928 nondonors (17%) (weighted hazard ratio, 1.11 [95% CI, 0.75-1.66]). The longitudinal change in mean blood pressure was similar in donors and nondonors. After the initial drop in donors’ eGFR after nephrectomy (mean, 32 mL/min/1.73 m2), donors had a 1.4-mL/min/1.73 m2 (95% CI, 1.2-1.5) per year lesser decline in eGFR than nondonors. However, more donors than nondonors had an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up (438/924 [47%] vs 49/928 [5%]). Albuminuria occurred in 132 of 905 donors (15%) and 95 of 904 nondonors (11%) (weighted hazard ratio, 1.46 [95% CI, 0.97-2.21]); the weighted between-group difference in the albumin to creatinine ratio was 1.02 (95% CI, 0.88-1.19).Conclusions and RelevanceIn this cohort study of living kidney donors and nondonors with the same follow-up schedule, the risks of hypertension and albuminuria were not significantly different. After the initial drop in eGFR from nephrectomy, donors had a slower mean rate of eGFR decline than nondonors but were more likely to have an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up.Trial RegistrationClinicalTrials.gov Identifier: NCT00936078

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Association of Early Postdonation Renal Function With Subsequent Risk of End-Stage Renal Disease in Living Kidney Donors

et al. 2020

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IMPORTANCE Living kidney donation is associated with increased long-term risk of end-stage renal disease (ESRD). An early postdonation marker of ESRD risk could improve postdonation risk assessment and counseling for kidney donors and allow early intervention for donors at increased risk.OBJECTIVE To determine the association between renal function in the first 6 months postdonation and subsequent risk of ESRD in kidney donors. DESIGN, SETTING, AND PARTICIPANTSThis secondary analysis of a prospective national cohort uses a population-based registry of all living kidney donors in the United States between

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A Prospective Controlled Study of Living Kidney Donors: Three-Year Follow-up

Cited by 150 publications

References 51 publications

Abnormalities in biomarkers of mineral and bone metabolism in kidney donors

Abnormalities in biomarkers of mineral and bone metabolism in kidney donors

Hypertension and Kidney Function After Living Kidney Donation

Association of Early Postdonation Renal Function With Subsequent Risk of End-Stage Renal Disease in Living Kidney Donors

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