Changes in glomerular filtration rate after donation in living kidney donors: a single-center cohort study

Abstract

Purpose: A number of studies have reported on decline in glomerular filtration rate (GFR) after donation in Japanese living kidney donors. The purpose of the present study was to examine the clinicopathological factors associated with changes in GFR after donation in living kidney donors.

Methods: We reviewed the charts of living kidney donors (n = 294) and monitored estimated GFR (eGFR) values from the time of 0-h kidney biopsy until 3 years after donation. We assessed donor age, gender, body mass index, blood pressure, urinalysis, and several other clinical parameters including the severity of glomerulosclerosis and arteriosclerosis.

Results: The grade of arteriosclerosis in 0-h biopsy specimens was higher in the older donor group (57-76 years) than in the younger donor group (30-56 years). Mean donor eGFR at the time of the donation was 80.1 ± 13.6 ml/min/1.73 m(2). Most of the living kidney donors in this study developed stage 3 chronic kidney disease (CKD). The mean changes in eGFR at 1-3 years after donation showed a steady state that was distinct from the generally accepted notion that GFR declines with age. Multivariate regression analyses showed that the changes in eGFR were negatively associated with age (r = -0.21, P < 0.001) and preoperative eGFR (r = -0.18, P < 0.001), but not associated with the grade of glomerulosclerosis and arteriosclerosis.

Conclusion: Donor age and pre-GFR at the time of nephrectomy were associated with decline in kidney function in living kidney donors after donation. Most of the donors developed stage 3 CKD within 3 years after donation but without subsequent progression, at least for several years.