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 I.
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 - Funding Information:
We thank T.M. Royaards, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands, for her contribution to the data collection and management of the replication cohort.
Publisher Copyright:
© 2022 International Society of Nephrology
PY - 2022/6/1
Y1 - 2022/6/1
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/1.73m2. 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/1.73m2. 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 125I-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/1.73m2. 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/1.73m2. 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 125I-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.
UR - http://www.scopus.com/inward/record.url?scp=85127313620&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2022.01.034
DO - 10.1016/j.kint.2022.01.034
M3 - Article
C2 - 35227691
AN - SCOPUS:85127313620
SN - 0085-2538
VL - 101
SP - 1251
EP - 1259
JO - Kidney International
JF - Kidney International
IS - 6
ER -