Hypertension and obesity in living kidney donors

Mohamed, Mahmoud; Daoud, Ahmed; Quadri, Syed A.; Casey, Michael J.; Salas, Mariah Aurora Posadas; Rao, Velidi H.; Fülöp, Tibor; Soliman, Karim

doi:10.5500/wjt.v11.i6.180

Cited by 4 publications

(5 citation statements)

References 45 publications

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“…We did not find a significant effect on graft outcomes for the other factors studied (hypertension, dyslipidemia, smoking, proteinuria, and obesity), or for the association of factors, although their impact has been described in other cohorts [9,23,36]. Remarkably, in the "problem" group (age < 50 and eGFR < 90 mL/min/1.73 m 2 ), LDs had significantly more diagnoses of hypertension (21 vs. 6%, p = 0.004) vs. those in the same age group = with higher eGFRs, which could also indicate unrecognized kidney disease.…”

Section: Discussioncontrasting

confidence: 61%

“…It is associated with structural, hemodynamic, and metabolic alterations in the kidneys. Despite this, several studies, including ours, have failed to find significance in the immediate and short-term post-transplant recipient outcomes between normal-weight and overweight and obese donors [36]. We must note that we only accepted those obese donors with BMIs near 30 who showed the ability to lose weight and maintain a lower weight before donating.…”

Section: Discussionmentioning

confidence: 89%

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Living Donors’ Age Modifies the Impact of Pre-Donation Estimated Glomerular Filtration Rate on Graft Survival

Almeida,

Ribeiro,

Silvano

et al. 2023

JCM

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Background: The global scarcity of organs for kidney transplants (KTs) has led to the increased acceptance of living donors (LDs) with minor abnormalities to increase the donor pool.. We sought to evaluate the effects of some of these LDs’ clinical characteristics (older age, borderline renal function, hypertension, dyslipidemia, smoking, and obesity) on graft outcomes. Methods: We studied 352 recipients of LDKTs (1998–2020). Firstly, considering the recipients and KT variables, we identified relevant predictors of overall and censored graft failure (GF). Then, adjusting for these predictors, we explored LD variables as predictors of overall and censored GF in a multivariable Cox model. Results: The recipients from LD with higher eGFR (≥90 mL/min/1.73 m2) had significantly better overall and censored graft survival GS) at 15 y after KT (respectively, 67 and 75% vs. 46 and 46%, p < 0.001). Importantly, none of the remaining LD factors which were evaluated (hypertension, dyslipidemia, smoking, proteinuria, and obesity) were independent predictors of GF. In recipients from LDs < 50 y, having an eGFR < 90 was an independent predictor of overall GF [adjusted HR (95%CI) of 2.578 (1.120–5.795)] and censored GF [adjusted HR (95%CI) of 3.216 (1.300–7.959)], compared to recipients from LDs with eGFR ≥ 90. Contrarily, when donors were older, no difference in the risk of GF was observed between eGFR categories. Conclusion: In our cohort, lower pre-donation eGFR had an impact on GS only in younger LDs. An age-adjusted eGFR cutoff may be pursued for improved donor admissibility.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 89%

Living Donors’ Age Modifies the Impact of Pre-Donation Estimated Glomerular Filtration Rate on Graft Survival

Almeida,

Ribeiro,

Silvano

et al. 2023

JCM

View full text Add to dashboard Cite

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“…There is epidemiological evidence that living kidney donors (LKDs) have an increased probability of endstage kidney disease compared with matched nondonors. [1][2][3] This may be related to risk factors such as hypertension and obesity [4][5][6] but is also more common in donors with low predonation renal function or higher age. 1,2 In healthy and hypertensive individuals, a low glomerular number has been associated with development of hypertension and chronic kidney disease (CKD) 7,8 -a phenomenon possibly related to single-nephron hyperfiltration and accelerated glomerular sclerosis.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Renal Function in Living Kidney Donors and Recipients of Living Donor Kidneys Using Quantitative Histology

et al. 2022

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Background. Living kidney donors (LKDs) are at increased risk of chronic kidney disease, whereas transplant recipients experience progressive reduction of graft function. We examined the predictive value of quantitative stereology on renal function in LKDs and recipients of living donor kidneys, based on perioperative biopsies from the donated kidney. Methods. Cortex volume of both donor kidneys was determined by contrast-enhanced computed tomography and single-kidney glomerular filtration rate (GFR) by 51chrome-EDTA clearance together with renography. Glomerular density was used to estimate total glomeruli number in addition to glomerular volume, glomerular sclerosis, kidney fibrosis, and arteriole dimensions. GFR measurements were repeated 1 y after transplantation in both LKDs and recipients. Associations between GFR at follow-up and cortex volume and histomorphometric parameters after adjustment of age, gender, body mass index, smoking status, 24-h blood pressure, and single-kidney GFR were examined. Results. We included 49 LKDs (age, 51 ± 12 y) and 51 recipients (age, 44 ± 13 y). At follow-up, GFR was 71 ± 16 mL/min in LKDs and 61 ± 18 mL/min in recipients with hyperfiltration being more prominent in LKDs (30.4%) as compared to recipients (16.4%; P < 0.05). One-year GFR in donors correlated to cortex volume (P < 0.001) but not to any histological parameters, whereas GFR in recipients correlated to the amount of interstitial fibrosis (P < 0.01) but not to other histological parameters or cortex volume. Conclusions. Kidney cortex volume, but not renal histology parameters, predicts 1-y renal outcome in LKDs. In contrast, the amount of interstitial fibrosis, but not cortex volume, predicts 1-y graft function in recipients.

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“…[7] In a broader sense, it has been shown that obesity and HTN have an additive effect on decreasing glomerular filtration rate compensation after kidney donation. [8] Smoking has been shown to increase the risk of CKD, notably hypertensive nephropathy and diabetic nephropathy. Furthermore, numerous animal and human studies have shown that hyperlipidemia accelerates the rate of kidney disease progression.…”

Section: Discussionmentioning

confidence: 99%

“…A higher body mass index was found to be directly associated with the development and progression of proteinuria in people without kidney disease, and obesity has been proven to be an independent risk factor for the development of kidney failure (7). In a broader sense, it has been shown that obesity and HTN have an additive effect on decreasing GFR compensation after kidney donation (8). Smoking has been shown to increase the risk of CKD, notably hypertensive nephropathy and diabetic nephropathy.…”

Section: Discussionmentioning

confidence: 99%