A prospective controlled study of living kidney donors: Three-year follow-up

Bertram L. Kasiske, Teresa Anderson-Haag, Ajay K. Israni, Roberto S. Kalil, Paul L. Kimmel, Edward S. Kraus, Rajiv Kumar, Andrew A. Posselt, Todd E. Pesavento, Hamid Rabb, Michael W. Steffes, Jon J. Snyder, Matthew R. Weir

Research output: Contribution to journalArticle

Abstract

Background There have been few prospective controlled studies of kidney donors. Understanding the pathophysiologic effects of kidney donation is important for judging donor safety and improving our understanding of the consequences of reduced kidney function in chronic kidney disease. Study Design Prospective, controlled, observational cohort study. Setting & Participants 3-year follow-up of kidney donors and paired controls suitable for donation at their donor's center. Predictor Kidney donation. Outcomes Medical history, vital signs, glomerular filtration rate, and other measurements at 6, 12, 24, and 36 months after donation. Results At 36 months, 182 of 203 (89.7%) original donors and 173 of 201 (86.1%) original controls continue to participate in follow-up visits. The linear slope of the glomerular filtration rate measured by plasma iohexol clearance declined 0.36 ± 7.55 mL/min per year in 194 controls, but increased 1.47 ± 5.02 mL/min per year in 198 donors (P = 0.005) between 6 and 36 months. Blood pressure was not different between donors and controls at any visit, and at 36 months, all 24-hour ambulatory blood pressure parameters were similar in 126 controls and 135 donors (mean systolic blood pressure, 120.0 ± 11.2 [SD] vs 120.7 ± 9.7 mm Hg [P = 0.6]; mean diastolic blood pressure, 73.4 ± 7.0 vs 74.5 ± 6.5 mm Hg [P = 0.2]). Mean arterial pressure nocturnal dipping was manifest in 11.2% ± 6.6% of controls and 11.3% ± 6.1% of donors (P = 0.9). Urinary protein-creatinine and albumin-creatinine ratios were not increased in donors compared with controls. From 6 to 36 months postdonation, serum parathyroid hormone, uric acid, homocysteine, and potassium levels were higher, whereas hemoglobin levels were lower, in donors compared with controls. Limitations Possible bias resulting from an inability to select controls screened to be as healthy as donors, short follow-up duration, and dropouts. Conclusions Kidney donors manifest several of the findings of mild chronic kidney disease. However, at 36 months after donation, kidney function continues to improve in donors, whereas controls have expected age-related declines in function.

Original languageEnglish (US)
Pages (from-to)114-124
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume66
Issue number1
DOIs
StatePublished - Jul 1 2015

Keywords

  • Assessing Long Term Outcomes in Living Kidney Donors (ALTOLD)
  • Chronic kidney disease (CKD)
  • glomerular filtration rate (GFR)
  • hemoglobin
  • homocysteine
  • kidney function
  • kidney transplantation
  • living kidney donation
  • mineral and bone disorders
  • parathyroid hormone (PTH)
  • patient safety
  • potassium
  • renal insufficiency
  • unilateral nephrectomy
  • uric acid

ASJC Scopus subject areas

  • Nephrology

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  • Cite this

    Kasiske, B. L., Anderson-Haag, T., Israni, A. K., Kalil, R. S., Kimmel, P. L., Kraus, E. S., Kumar, R., Posselt, A. A., Pesavento, T. E., Rabb, H., Steffes, M. W., Snyder, J. J., & Weir, M. R. (2015). A prospective controlled study of living kidney donors: Three-year follow-up. American Journal of Kidney Diseases, 66(1), 114-124. https://doi.org/10.1053/j.ajkd.2015.01.019