Yonsei Med J.  2023 Mar;64(3):221-227. 10.3349/ymj.2022.0541.

Association of Pre- and Post-Donation Renal Function with Midterm Estimated Glomerular Filtration Rate in Living Kidney Donors: A Retrospective Study

• Park JH
• Kim SY
• Cho JS
• Shin D
• Ham SY
• Kim H
• Kwak YL

• KMID: 2539566
• DOI: http://doi.org/10.3349/ymj.2022.0541

Abstract

Purpose
The estimated glomerular filtration rate (eGFR) at 6 months after donation (eGFR _6m) is strongly associated with the risk of end-stage renal disease in living kidney donors. This study aimed to investigate the incidence of eGFR 6m <60 mL/min/1.73 m ² eGFR _6m <60) and identify the risk factors that can predict the occurrence of eGFR 6m <60 in living kidney donors.
Materials and Methods
Living kidney donors who underwent nephrectomy at Severance Hospital between January 2009 and December 2019 were identified. We excluded 94 of 1233 donors whose creatinine values at 6 months after donation were missing. The risk factors for eGFR _6m <60 were assessed using multivariate regression analysis. The optimal cutoff points for candidate risk factors for predicting eGFR _6m <60 occurrence were determined using the Youden index.
Results
The eGFR _6m <60 occurred in 17.3% of the participants. Older age (≥44 years), history of hypertension, lower preoperative eGFR (<101 mL/min/1.73 m ² ), and degree of increase in creatinine levels on postoperative day 2 compared to those before surgery (ΔCr2_pre) (≥0.39 mg/dL) increased the risk of eGFR _6m <60. The addition of ΔCr2_pre to preoperative eGFR yielded a higher predictive accuracy for predicting eGFR _6m <60 than that with preoperative eGFR alone {area under the receiver operating characteristic curve=0.886 [95% confidence interval (CI), 0.863–0.908] vs. 0.862 (95% CI, 0.838–0.887), p<0.001}.
Conclusion
The incidence of eGFR _6m <60 was 17.3%. Older age, lower preoperative eGFR, history of hypertension, and greater ΔCr2_pre were associated with the occurrence of eGFR _6m <60 after living donor nephrectomy. The combination of preoperative eGFR and ΔCr2_pre showed the highest predictive power for eGFR _6m <60.

Keyword

Creatinine; estimated glomerular filtration rate; eGFR at 6 months after donation; living donor nephrectomy; outcome