Are We Taking Proper Care of Living Donors? A Follow-up Study of Living Kidney Donors in Poland and Further Management Proposal

Rowińskí, W; Chmura, A.; Włodarczyk, Zbigniew; Ostrowski, Marek; Rutkowski, Bolesław; Domagała, Piotr; Dziewanowski, K.; Matych, Józef; Durlik, M.; Grenda, Ryszard

doi:10.1016/j.transproceed.2008.08.140

Cited by 5 publications

(2 citation statements)

References 13 publications

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“…Kidney functional adaptation may occur within a few months and kidney damage over 3 months can be considered as a chronic change [ 15 ]. Indeed, most donors show a plateau of increased eGFR within several months [ 16 ]. In this regard, we used the eGFR percent change at 1-month post-donation as a marker for early renal recovery.…”

Section: Discussionmentioning

confidence: 99%

Insufficient early renal recovery and progression to subsequent chronic kidney disease in living kidney donors

Kim

Kang

Chae

et al. 2022

Korean J Intern Med

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Background/Aims: Renal recovery of a kidney donor after undergoing nephrectomy though challenging is essential. We aimed to examine the effect of estimated glomerular filtration rate (eGFR) percent change at 1-month post-donation on insufficient kidney function after kidney donation.Methods: A total of 3,952 living kidney donors who underwent donor nephrectomy from 1982 to 2019 from eight different tertiary hospitals in Korea were initially screened. Percent changes in the eGFR from baseline to 1-month post-donation were calculated. The degree of percent changes was categorized by quartile, and the 1st quartile was regarded as the group with the lowest decreased eGFR at 1-month after donation. The remaining eGFR less than 60 mL/min/1.73 m<sup>2</sup> was the end-point. The Cox proportional hazard model was used for evaluating the impact of initial eGFR and eGFR percent change at 1-month post-donation on the condition with remaining eGFR < 60 mL/ min/1.73 m<sup>2</sup>. In the multivariate analysis, we used variables with a p < 0.1 in the univariate analysis.Results: A total of 1,585 donors were included in the analysis. During 62.2 ± 49.3 months, 13.7% of donors showed renal insufficiency. The 4th (adjusted hazard ratio [aHR], 10.41; 95% confidence interval [CI], 5.15 to 21.04) and the 3rd (aHR, 4.29; 95% CI, 2.15 to 8.56) quartiles of percent change in eGFR and the pre-donation eGFR (aHR, 0.90; 95% CI, 0.88 to 0.92) were associated with the development of renal insufficiency.Conclusions: The impact of worse initial renal recovery on renal insufficiency was pronounced in donors with lower pre-donation eGFRs. Additionally, worse initial renal recovery of remaining kidney affected the long-term development of renal insufficiency in kidney donors.

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Section: Discussionmentioning

confidence: 99%

Insufficient early renal recovery and progression to subsequent chronic kidney disease in living kidney donors

Kim

Kang

Chae

et al. 2022

Korean J Intern Med

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“…In a Polish study by Rowinski et al ., the mean serum creatinine increased from 0.8 to 1.25 mg/dl and >2 mg/dl in two patients. [11] The eGFR (MDRD) had significantly decreased from 95 to 65 ml/min ( P < 0.05) corresponding to a 31% decrease in GFR. Our results are in concordance with the results of above two studies, although they followed donors for a longer duration.…”

Section: Discussionmentioning

confidence: 99%

To study the impact of donor nephrectomy on blood pressure as measured by ambulatory blood pressure monitoring and renal function

et al. 2019

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Prospective living kidney donors need meticulous evaluation prior to kidney donation. Ambulatory blood pressure monitoring (ABPM) is considered the reference standard for diagnosing hypertension. With no prior study available in India in this context, we undertook this study to evaluate the utility of ABPM in kidney donors and effect of donor nephrectomy on renal function. This was a prospective observational study involving healthy prospective kidney donors between 18 and 70 years with normal office blood pressure measurements (OBPM). Detailed clinical and biochemical parameters were recorded. OBPM and 24-hour ABPM was done preoperatively and 3 months following donor nephrectomy. There were 51 donors with a mean age of 46.1 ± 11.3 years, of which 40 (78.4%) were females. Preoperatively, three (5.8%) donors were hypertensive on ABPM but normal on OBPM ( P = 0.08). Three months post nephrectomy, hypertension was present in seven (13.7%) donors by ABPM, while only two (3.9%) donors were diagnosed as hypertensive by OBPM ( P = 0.02). Median pre-nephrectomy proteinuria was 70 mg (10 mg–180 mg) with a mean estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula of 86.86 ± 19.1 ml/min. Six donors developed >300 mg/day proteinuria, and 17 (33.3%) had a 24-hour urinary protein excretion greater than 150 mg/day. Mean serum creatinine (0.79 ± 0.11 vs 1.03 ± 0.16 mg/dl) significantly increased post donation, more so in donors >55 years of age (1.14 ± 0.25 mg/dl). Our study shows that in transplant donors, ABPM is better for diagnosing hypertension, which otherwise remains masked in 10% of the donors on routine OBPM. Significance of post-nephrectomy hypertension and increasing proteinuria needs further evaluation.

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At What Price Kidneys From Complex Donors While Patients Die on the Waiting List: A Word of Caution

Rowińskí

Czerwiński

Kosieradzki

2010

Transplantation Proceedings

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Are We Taking Proper Care of Living Donors? A Follow-up Study of Living Kidney Donors in Poland and Further Management Proposal

Cited by 5 publications

References 13 publications

Insufficient early renal recovery and progression to subsequent chronic kidney disease in living kidney donors

Insufficient early renal recovery and progression to subsequent chronic kidney disease in living kidney donors

To study the impact of donor nephrectomy on blood pressure as measured by ambulatory blood pressure monitoring and renal function

At What Price Kidneys From Complex Donors While Patients Die on the Waiting List: A Word of Caution

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