Changes in Biomarkers Associated with Living Kidney Donation

Huan, Yonghong; Kapoor, Shiv; DeLoach, Stephanie; Ommen, Elizabeth S.; Meyers, Kevin; Townsend, Raymond R.

doi:10.1159/000354312

Cited by 6 publications

(10 citation statements)

References 42 publications

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“…Of the previous 9 studies, 5 were prospective, comparing changes before and after donation but did not include normal controls. 6, 7, 10, 12, 13 Three others were retrospective, cross-sectional studies, 8, 9, 11 and 1 of these studies included non-donor controls. 11 Only 1 of the 9 studies was both prospective and controlled.…”

Section: Discussionmentioning

confidence: 99%

Abnormalities in biomarkers of mineral and bone metabolism in kidney donors

Kasiske

Kumar

Kimmel

et al. 2016

Kidney International

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Previous studies have suggested that kidney donors may have abnormalities of mineral and bone metabolism typically seen in chronic kidney disease. This may have important implications for the skeletal health of living kidney donors and for our understanding of the pathogenesis of long term mineral and bone disorders in chronic kidney disease. In this prospective study, 182 of 203 kidney donors and 173 of 201 paired normal controls had markers of mineral and bone metabolism measured before and at 6 and 36 months after donation (ALTOLD Study). Donors had significantly higher serum concentrations of intact parathyroid hormone (24.6% and 19.5%) and fibroblast growth factor-23 (9.5% and 8.4%) at 6 and 36 months, respectively, as compared to healthy controls, and significantly reduced tubular phosphate reabsorption (−7.0% and −5.0%) and serum phosphate concentrations (−6.4% and −2.3%). Serum 1,25-dihydroxyvitamin D3 concentrations were significantly lower (−17.1% and −12.6%), while 25-hydroxyvitamin D (21.4% and 19.4%,) concentrations were significantly higher in donors compared to controls. Moreover, significantly higher concentrations of the bone resorption markers, carboxyterminal cross-linking telopeptide of bone collagen (30.1% and 13.8%) and aminoterminal cross-linking telopeptide of bone collagen (14.2% and 13.0%), and the bone formation markers, osteocalcin (26.3% and 2.7%), and procollagen type I N-terminal propetide (24.3% and 8.9%) were observed in donors. Thus, kidney donation alters serum markers of bone metabolism that could reflect impaired bone health. Additional long term studies that include assessment of skeletal architecture and integrity are warranted in kidney donors.

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Section: Discussionmentioning

confidence: 99%

Abnormalities in biomarkers of mineral and bone metabolism in kidney donors

Kasiske

Kumar

Kimmel

et al. 2016

Kidney International

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“…Features in common give us valuable mechanistic information for possible mediators of cardiac disease. 3 , 4 , 5 , 8 , 15 , 18 , 25 , 26 , 27 , 30 , 33 , 38 , 46 , 47 , 48 , 63 , 65 , 66 ACR, urine albumin to creatinine ratio; FGF23, fibroblast growth factor 23; GFR, glomerular filtration rate; PTH, parathyroid hormone; RAAS, renin-angiotensin-aldosterone system; NT-proBNP, N terminal pro-brain natriuretic peptide. …”

Section: Discussionmentioning

confidence: 99%

“… 44 Expression of FGF23 receptors increase in the hearts of those with CKD and it is associated with LVH. 45 FGF23 has been found to increase both after nephrectomy and compared with controls in a number of donor studies 4 , 46 , 47 , 48 although there are some inconsistencies which may be related to the use of different assays. 43 , 49 …”

Section: Vascular Changesmentioning

confidence: 99%

“…A variety of other biomarkers of cardiac disease have been found to be deranged in CKD and associated with cardiac events, death, and renal progression. 46 , 65 The data examining these biomarkers in donors are summarized online (please see Supplementary Table S2 online).…”

Section: Vascular Changesmentioning

confidence: 99%

“… ˄ Huan. 46 2013 LKD Donors = 34 No controls Longitudinal. Baseline and 6 mo No significant difference in IL-6 or TNFα after donation.…”

Section: Table S1mentioning

confidence: 99%

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Chronic kidney disease as a cardiovascular risk factor: lessons from kidney donors

Price

Edwards

Hayer

et al. 2018

Journal of the American Society of Hypertension

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Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease but is often associated with other risks such as diabetes and hypertension and can be both a cause and an effect of cardiovascular disease. Although epidemiologic data of an independent association of reduced glomerular filtration rate with cardiovascular risk are strong, causative mechanisms are unclear.Living kidney donors provide a useful model for assessing the “pure” effects of reduced kidney function on the cardiovascular system. After nephrectomy, the glomerular filtration rate ultimately falls by about one-third so many can be classified as having chronic kidney disease stages 2 or 3. This prompts concern based on the data showing an elevated cardiovascular risk with these stages of chronic kidney disease. However, initial data suggested no increase in adverse cardiovascular effects compared with control populations. Recent reports have shown a possible late increase in cardiovascular event rates and an early increase in left ventricular mass and markers of risk such as urate and albuminuria. The long-term significance of these small changes is unknown. More detailed and long-term research is needed to determine the natural history of these changes and their clinical significance.

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Fracture Risk Among Living Kidney Donors 25 Years After Donation

Maradit Kremers,

Grossardt,

Miller

et al. 2024

JAMA Netw Open

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ImportanceLiving kidney donors may have an increased risk of fractures due to reductions in kidney mass, lower concentrations of serum 1,25-dihydroxyvitamin D, and secondary increases in serum parathyroid hormone.ObjectiveTo compare the overall and site-specific risk of fractures among living kidney donors with strictly matched controls from the general population who would have been eligible to donate a kidney but did not do so.Design, Setting, and ParticipantsThis survey study was conducted between December 1, 2021, and July 31, 2023. A total of 5065 living kidney donors from 3 large transplant centers in Minnesota were invited to complete a survey about their bone health and history of fractures, and 16 156 population-based nondonor controls without a history of comorbidities that would have precluded kidney donation were identified from the Rochester Epidemiology Project and completed the same survey. A total of 2132 living kidney donors and 2014 nondonor controls responded to the survey. Statistical analyses were performed from May to August 2023.ExposureLiving kidney donation.Main Outcomes and MeasuresThe rates of overall and site-specific fractures were compared between living kidney donors and controls using standardized incidence ratios (SIRs).ResultsAt the time of survey, the 2132 living kidney donors had a mean (SD) age of 67.1 (8.9) years and included 1245 women (58.4%), and the 2014 controls had a mean (SD) age of 68.6 (7.9) years and included 1140 women (56.6%). The mean (SD) time between donation or index date and survey date was 24.2 (10.4) years for donors and 27.6 (10.7) years for controls. The overall rate of fractures among living kidney donors was significantly lower than among controls (SIR, 0.89; 95% CI, 0.81-0.97). However, there were significantly more vertebral fractures among living kidney donors than among controls (SIR, 1.42; 95% CI, 1.05-1.83).Conclusions and RelevanceThis survey study found a reduced rate of overall fractures but an excess of vertebral fractures among living kidney donors compared with controls after a mean follow-up of 25 years. Treatment of excess vertebral fractures with dietary supplements such as vitamin D3 may reduce the numbers of vertebral fractures and patient morbidity.

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Changes in Biomarkers Associated with Living Kidney Donation

Cited by 6 publications

References 42 publications

Abnormalities in biomarkers of mineral and bone metabolism in kidney donors

Abnormalities in biomarkers of mineral and bone metabolism in kidney donors

Chronic kidney disease as a cardiovascular risk factor: lessons from kidney donors

Fracture Risk Among Living Kidney Donors 25 Years After Donation

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