Effects of Preexistent Hypertension on Blood Pressure and Residual Renal Function After Donor Nephrectomy

Tent, Hilde; Sanders, Jan-Stephan; Rook, Mieneke; Hofker, H. Sijbrand; Ploeg, Rutger J.; Navis, Gerjan; Heide, Jaap J. Homan van der

doi:10.1097/tp.0b013e318240e9b9

Cited by 48 publications

(29 citation statements)

References 20 publications

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“…Bugge et al studied eight donors over the immediate 24 h post-nephrectomy [25]; GFR and eRPF increased by 70 % within 1 h and was maintained over 24 h. Pabico et al reported mean post-nephrectomy GFR increase of 37 % and mean eRPF of 55 %; the FF was not significantly different pre-and post-nephrectomy [26], similar to the results reported by Tent et al [27]. Ter Wee et al [28] reported on 20 adult donors pre-and 41 days post-donation; GFR and eRPF increased by 65 and 69 % while the FF had decreased significantly from 0.251 to 0.238.…”

Section: Discussionsupporting

confidence: 83%

Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors Pre-nephrectomy and post-nephrectomy

Cutajar

Hilton²,

Olsburgh³

et al. 2015

Eur Radiol

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Section: Discussionsupporting

confidence: 83%

Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors Pre-nephrectomy and post-nephrectomy

Cutajar

Hilton²,

Olsburgh³

et al. 2015

Eur Radiol

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“…Short-term studies have shown that selected white donors with hypertension well controlled by a single drug at the time of donation do not have increased risks (52,53). With respect to diabetes, Ibrahim et al reported on 154 donors who developed type 2 diabetes (T2DM) a mean 6 SD of 17.769 years after donation (54).…”

Section: Kidney Donors Are Not Protected From Riskmentioning

confidence: 99%

The Unjustified Classification of Kidney Donors as Patients with CKD

Matas

Ibrahim

2013

Clinical Journal of the American Society of Nephrology

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SummaryUnilateral nephrectomy for kidney donation results in loss of about 30% of baseline GFR, leaving some donors with GFR <60 ml/min per 1.73 m 2 , the threshold for the diagnosis CKD. This has resulted in insurability problems for some donors. This article reviews the definition of CKD, risks associated with CKD, and large follow-up studies on the vital status and risk of ESRD in kidney donors. It also provides evidence that kidney donors, despite having reduced GFR, are not at increased risk for CKD-associated morbidity and mortality. Epidemiologic studies, most with follow-up <10 years, have shown an association between GFR <60 ml/min per 1.73 m 2 and higher mortality and progression to ESRD. Low GFR in the absence of any other markers for kidney disease, however, conveys attenuated or minimal risk. Of note, studies of long-term kidney donor outcomes (6-45 years) have not shown excess mortality or ESRD. The limitation of the collective evidence is that the increased risks associated with GFR <60 ml/min per 1.73 m 2 were demonstrated in much larger cohorts than those reported for kidney donor outcomes, but donor outcome studies have substantially longer follow-up. On the basis of current findings, kidney donors with low GFR and no other signs of kidney disease should not be classified as having CKD. This is definitely not the reward they deserve, and, more important, the implications of reduced GFR in donors are not associated with unfavorable outcomes. In addition, the increasing number of patients who are interested in and are eligible for a kidney transplant has not been associated with a commensurate increase in the number of DD organs. This has resulted in a markedly longer waiting time on the list. The increasing waiting time for a DD transplant and the poor shortand mid-term results with dialysis have put increased emphasis on living donation. The major disadvantage of an LD transplant is the risk to the donor. Studies over the last three decades have noted a perioperative donor mortality rate of 3 in 10,000 (0.03%) and a major complication rate of ,1% (3-5). Laparoscopic nephrectomy is associated with quicker recovery than open nephrectomy but carries similar risk. To date, long-term follow-up studies report that donors, compared with controls, have similar or better survival rates, and perhaps lower rates of development of . In addition, donor quality of life after donation is excellent (15). Of concern, however, is that recent studies in the nondonor general population have suggested that reduced renal function is associated with increased cardiovascular and all-cause mortality; consequently, some former donors have had problems obtaining life and health insurance or are being forced to pay higher premiums (16,17). At the same time, some former donors with stable renal function have been labeled as having CKD. Herein, we review level of renal function after donation and the data on long-term survival and risk of ESRD after kidney donation. Definition of CKDMany observation studies have shown the a...

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“…13 Studies that have focused on the outcome of donors with preexisting hypertension have been small; a Dutch study that followed 29 and 13 donors with preexisting hypertension to 1 and 5 years postdonation, respectively, found no difference in postdonation BP or GFR compared with normotensive controls. 14 Textor et al 15 reported no difference in GFR between 24 living donors with preexisting hypertension and normotensive controls followed in the first 1 year postdonation, and BP remained easy to control in the hypertensive group postdonation. 15 In a recent study, 14 Japanese living donors with hypertension and high-normal albumin-tocreatinine ratios (15-30 mg/g) had similar outcomes to normotensive donors in terms of kidney function over 2 years of follow-up.…”

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confidence: 99%

The Association of Predonation Hypertension with Glomerular Function and Number in Older Living Kidney Donors

Lenihan¹,

Busque

Derby³

et al. 2015

Journal of the American Society of Nephrology

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The effect of preexisting hypertension on living donor nephron number has not been established. In this study, we determined the association between preexisting donor hypertension and glomerular number and volume and assessed the effect of predonation hypertension on postdonation BP, adaptive hyperfiltration, and compensatory glomerular hypertrophy. We enrolled 51 living donors to undergo physiologic, morphometric, and radiologic evaluations before and after kidney donation. To estimate the number of functioning glomeruli (N FG ), we divided the whole-kidney ultrafiltration coefficient (K f ) by the single-nephron ultrafiltration coefficient (SNK f ). Ten donors were hypertensive before donation. We found that, in donors ages .50 years old, preexisting hypertension was associated with a reduction in N FG . In a comparison of 10 age-and sex-matched hypertensive and normotensive donors, we observed more marked glomerulopenia in hypertensive donors (N FG per kidney, 359,4996128,929 versus 558,2396205,152; P=0.02). Glomerulopenia was associated with a nonsignificant reduction in GFR in the hypertensive group (89612 versus 95616 ml/min per 1.73 m 2 ). We observed no difference in the corresponding magnitude of postdonation BP, hyperfiltration capacity, or compensatory renocortical hypertrophy between hypertensive and normotensive donors. Nevertheless, we propose that the greater magnitude of glomerulopenia in living kidney donors with preexisting hypertension justifies the need for long-term follow-up studies.

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Effects of Preexistent Hypertension on Blood Pressure and Residual Renal Function After Donor Nephrectomy

Abstract: In summary, hypertensive living kidney donors have similar outcome in terms of blood pressure and renal function as control donors, early and 1 and 5 years after donation.

Cited by 48 publications

References 20 publications

Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors Pre-nephrectomy and post-nephrectomy

Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors Pre-nephrectomy and post-nephrectomy

The Unjustified Classification of Kidney Donors as Patients with CKD

The Association of Predonation Hypertension with Glomerular Function and Number in Older Living Kidney Donors

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