Insulin Sensitivity After Living Donor Nephrectomy

Tanrıöver, Bekir; Lingvay, Ildiko; Ahmed, Firas S.; Sandikçi, Burhaneddi̇n; Mohan, Sumit; Cremers, Serge; Karmally, Wahida; Mohan, Prince; Newhouse, Jeffrey H.; Ragunathan, Sneha; AbdulRahim, Nashila; Ariyamuthu, Venkatesh Kumar; Ratner, Lloyd E.; Cohen, David J.

doi:10.1016/j.transproceed.2021.06.007

Cited by 2 publications

(6 citation statements)

References 30 publications

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“…A case–control study found that the homeostasis model assessment of insulin resistance (HOMA‐IR) in kidney donors a few years after donation (mean duration 30.4 months after donation) was significantly higher than that of the non‐donor controls 4 . A recent cohort study reported that indexes of insulin resistance (HOMA‐IR and AUC insulin/glucose) in the living kidney donors increased 3 months after nephrectomy 16 …”

Section: Discussionmentioning

confidence: 99%

Metabolic effects of kidney donation: A Bayesian analysis of matched cohorts

et al. 2022

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The kidney is a notable site of glycolysis, gluconeogenesis, and fatty acid oxidation. Loss of a kidney after kidney donation might, therefore, affect the glucose and lipid metabolism of the donors. This matched cohort study investigated the effect of nephrectomy on glucose and lipid metabolisms using Bayesian hypothesis testing. There were 77 pairs of matched donor‐control pairs in the present study. Clinical and laboratory data of the participants, at baseline and 1‐year, were extracted from electronic medical records. Comparisons between donor and control groups were performed using the Bayesian independent samples t‐test or Bayesian Mann–Whitney test. The Bayes Factor for alternative hypothesis over null hypothesis (BF10) was used to compare the two competing hypotheses. The BF10 of 3 or more was considered evidence for the alternative hypothesis. Comparing changes from baseline to 1‐year between donors and controls, the BF10 of triglycerides, high‐density lipoprotein cholesterol (HDL‐C), triglyceride‐glucose (TyG) index of insulin resistance, and estimated glomerular filtration rate (eGFR) were 7.95, 3.96, 30.13, and 1.32 x 1041, respectively signifying that the change of these variables in the donors differed from those in the controls (alternative hypothesis). Triglyceride, HDL‐C, and TyG index of the donors increased more than those of the controls while eGFR of the donor decreased more than that of the controls. Our data suggest that triglycerides and insulin resistance increase after donor nephrectomy. Kidney donors should be informed about these metabolic changes and should adhere to lifestyle recommendations that may mitigate insulin resistance.

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Section: Discussionmentioning

confidence: 99%

Metabolic effects of kidney donation: A Bayesian analysis of matched cohorts

et al. 2022

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“…Second, however, LKDs may be at greater risk for diabetes development compared to non-donors in subsequent decades due to a greater degree and/or earlier development of insulin resistance. The small sample studied in Tanriover et al is a limitation yet provides further evidence of the paucity of data regarding the metabolic implications of living kidney donation [25]. Should the findings be replicated in a larger cohort, it would further emphasize the critical importance of longitudinal studies of LKDs with obesity to adequately assess diabetes development in later decades.…”

Section: Plos Onementioning

confidence: 99%

“…A final possible explanation for longer diabetes-free survival among LKDs with obesity in the first decade post-donation may be rooted in altered insulin and glucose metabolism following donor nephrectomy. A recent prospective study from Tanriover et al evaluated insulin sensitivity pre-donation and 3 months post-donation among nine LKDs who demonstrated significantly greater insulin, but similar glucose concentrations, and lower measures of insulin sensitivity post-donation [25]. Notably, the decreases in insulin sensitivity were greater among four LKDs with obesity [25].…”

Section: Plos Onementioning

confidence: 99%

“…A recent prospective study from Tanriover et al evaluated insulin sensitivity pre-donation and 3 months post-donation among nine LKDs who demonstrated significantly greater insulin, but similar glucose concentrations, and lower measures of insulin sensitivity post-donation [25]. Notably, the decreases in insulin sensitivity were greater among four LKDs with obesity [25]. Understanding hyperinsulinemia fosters insulin resistance [45], but insulin resistance may persist for approximately a decade prior to the development of pancreatic beta-cell insufficiency [46], the implications of these data are twofold.…”

Section: Plos Onementioning

confidence: 99%

“…The 2017 Kidney Disease: Improving Global Outcome practice guidelines for living donation outline the rigorous testing required for LDKs, and emphasize the need for greater understanding of donation-attributable risk as part of its framework for LKD selection [19]. While data regarding the metabolic impact of donor nephrectomy are sparse, it is well-established that kidneys maintain a vital role in both gluconeogenesis and insulin clearance [25][26][27]. Thus, it is plausible that LKDs experience altered insulin and glucose metabolism post-donation.…”

Section: Introductionmentioning

confidence: 99%

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Diabetes-free survival among living kidney donors and non-donors with obesity: A longitudinal cohort study

et al. 2022

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Background Approval of living kidney donors (LKD) with end-stage kidney disease (ESKD) risk factors, such as obesity, has increased. While lifetime ESKD development data are lacking, the study of intermediate outcomes such as diabetes is critical for LKD safety. Donation-attributable diabetes risk among persons with obesity remains unknown. The purpose of this study was to evaluate 10-year diabetes-free survival among LKDs and non-donors with obesity. Methods This longitudinal cohort study identified adult, LKDs (1976–2020) from 42 US transplant centers and non-donors from the Coronary Artery Risk Development in Young Adults (1985–1986) and the Atherosclerosis Risk in Communities (1987–1989) studies with body mass index ≥30 kg/m2. LKDs were matched to non-donors on baseline characteristics (age, sex, race, body mass index, systolic and diastolic blood pressure) plus diabetes-specific risk factors (family history of diabetes, impaired fasting glucose, smoking history). Accelerated failure time models were utilized to evaluate 10-year diabetes-free survival. Findings Among 3464 participants, 1119 (32%) were LKDs and 2345 (68%) were non-donors. After matching on baseline characteristics plus diabetes-specific risk factors, 4% (7/165) LKDs and 9% (15/165) non-donors developed diabetes (median follow-up time 8.5 (IQR: 5.6–10.0) and 9.1 (IQR: 5.9–10.0) years, respectively). While not significant, LKDs were estimated to live diabetes-free 2 times longer than non-donors (estimate 1.91; 95% CI: 0.79–4.64, p = 0.15). Conclusions LKDs with obesity trended toward living longer diabetes-free than non-donors with obesity, suggesting within the decade following donation there was no increased diabetes risk among LKDs. Further work is needed to evaluate donation-attributable diabetes risk long-term.

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Insulin Sensitivity After Living Donor Nephrectomy

Cited by 2 publications

References 30 publications

Metabolic effects of kidney donation: A Bayesian analysis of matched cohorts

Metabolic effects of kidney donation: A Bayesian analysis of matched cohorts

Diabetes-free survival among living kidney donors and non-donors with obesity: A longitudinal cohort study

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