TY - JOUR
T1 - Early increase in single-kidney glomerular filtration rate after living kidney donation predicts long-term kidney function
AU - van der Weijden, Jessica
AU - Mahesh, Shekar V. K.
AU - van Londen, Marco
AU - Bakker, Stephan J. L.
AU - Sanders, Jan-Stephan
AU - Navis, Gerjan
AU - Pol, Robert A.
AU - Roodnat, Joke
AU - Kho, Marcia M. L.
AU - Yakar, Derya
AU - Kwee, Thomas C.
AU - Nolte, Ilja M.
AU - Berger, Stefan P.
AU - De Borst, Martin H.
N1 - Copyright © 2022 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.
PY - 2022/6
Y1 - 2022/6
N2 - Single-kidney glomerular filtration rate (GFR) increases after living kidney donation due to compensatory hyperfiltration and structural changes. The implications of inter-individual variability in this increase in single-kidney GFR are unknown. Here, we aimed to identify determinants of the increase in single-kidney GFR at three-month postdonation, and to investigate its relationship with long-term kidney function. In a cohort study in 1024 donors, we found considerable inter-individual variability of the early increase in remaining single-kidney estimated GFR (eGFR) (median [25th-75th percentile]) 12 [8-18] mL/min/1.73m(2). Predonation eGFR, age, and cortical kidney volume measured by CT were the main determinants of the early postdonation increase in single-kidney eGFR. Individuals with a stronger early increase in single-kidney eGFR had a significantly higher five-year postdonation eGFR, independent of predonation eGFR and age. Addition of the postdonation increase in single-kidney eGFR to a model including predonation eGFR and age significantly improved prediction of a five-year postdonation eGFR under 50 mL/min/1.73m(2). Results at ten-year follow-up were comparable, while accounting for left-right differences in kidney volume did not materially change the results. Internal validation using 1251-iothalamate-based measured GFR in 529 donors and external validation using eGFR data in 647 donors yielded highly similar results. Thus, individuals with a more pronounced increase in single-kidney GFR had better long-term kidney function, independent of predonation GFR and age. Hence, the early postdonation increase in single-kidney GFR, considered indicative for kidney reserve capacity, may have additional value to eGFR and age to personalize follow-up intensity after living kidney donation.
AB - Single-kidney glomerular filtration rate (GFR) increases after living kidney donation due to compensatory hyperfiltration and structural changes. The implications of inter-individual variability in this increase in single-kidney GFR are unknown. Here, we aimed to identify determinants of the increase in single-kidney GFR at three-month postdonation, and to investigate its relationship with long-term kidney function. In a cohort study in 1024 donors, we found considerable inter-individual variability of the early increase in remaining single-kidney estimated GFR (eGFR) (median [25th-75th percentile]) 12 [8-18] mL/min/1.73m(2). Predonation eGFR, age, and cortical kidney volume measured by CT were the main determinants of the early postdonation increase in single-kidney eGFR. Individuals with a stronger early increase in single-kidney eGFR had a significantly higher five-year postdonation eGFR, independent of predonation eGFR and age. Addition of the postdonation increase in single-kidney eGFR to a model including predonation eGFR and age significantly improved prediction of a five-year postdonation eGFR under 50 mL/min/1.73m(2). Results at ten-year follow-up were comparable, while accounting for left-right differences in kidney volume did not materially change the results. Internal validation using 1251-iothalamate-based measured GFR in 529 donors and external validation using eGFR data in 647 donors yielded highly similar results. Thus, individuals with a more pronounced increase in single-kidney GFR had better long-term kidney function, independent of predonation GFR and age. Hence, the early postdonation increase in single-kidney GFR, considered indicative for kidney reserve capacity, may have additional value to eGFR and age to personalize follow-up intensity after living kidney donation.
KW - glomerular filtration rate
KW - living kidney donation
KW - postdonation adaptation
KW - postdonation outcomes
KW - renal functional reserve
KW - RENAL HEMODYNAMICS
KW - RESERVE CAPACITY
KW - HYPERFILTRATION
KW - RISK
KW - FEATURES
KW - DISEASE
KW - AGE
U2 - 10.1016/j.kint.2022.01.034
DO - 10.1016/j.kint.2022.01.034
M3 - Article
C2 - 35227691
SN - 0085-2538
VL - 101
SP - 1251
EP - 1259
JO - Kidney International
JF - Kidney International
IS - 6
ER -