Korean J Intern Med.
2022 Sep;37(5):1021-1030. 10.3904/kjim.2021.308.
Insufficient early renal recovery and progression to subsequent chronic kidney disease in living kidney donors
- Affiliations
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- 1Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- 2Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
- 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- 4Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- 5Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
- 6Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- 7Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- 8Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
- 9Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- KMID: 2533145
- DOI: http://doi.org/10.3904/kjim.2021.308
Abstract
- 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 m2 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 m2. 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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