Implications of excess weight on kidney donation: Long-term consequences of donor nephrectomy in obese donors

Serrano, Oscar K.; Sengupta, Bodhisatwa; Bangdiwala, Ananta S; Vock, David M.; Dunn, Ty B.; Finger, Erik B.; Pruett, Timothy L.; Matas, Arthur J.; Kandaswamy, Raja

doi:10.1016/j.surg.2018.07.015

Cited by 33 publications

(28 citation statements)

References 28 publications

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“…We used pharmacy claims as a measure of diabetes, a non‐obtrusive surrogate that avoids recall bias associated with survey studies, and complements information acquired though other study designs. Using this large, diverse national dataset, we confirmed associations of obesity at the time of donation with increased incidence of PDDM, previously reported among a single‐center sample of predominantly white donors . We also found that black and Hispanic donors, compared with white donors, had higher risk of insulin use after donation.…”

Section: Discussionsupporting

confidence: 86%

“…In one study that reported findings from two general population cohorts of 77 690 women and 46 060 men, higher BMI was associated with increased risk of diabetes at 10 years of follow‐up: compared with normal BMI, BMIs of 25 to <30, 30 to <35, and ≥35 kg/m 2 were associated with approximately 4, 10, and 20 times higher adjusted risk of diabetes . A single‐center US study that included 3752 predominantly white donors (1975‐2014, 17% obese) found PDDM rates by the end of follow‐up in 12% vs 6% of donors with baseline BMI ≥30 vs <30 kg/m 2 , and adjusted risk related to obesity was three times that of normal weight . Another smaller single‐center study of 388 donors from Egypt (1976‐2014) also found increased PDDM risk with higher BMI (4.1% in normal weight, 6% in overweight, and 25% in obese donors over follow‐up to 2014) .…”

Section: Discussionmentioning

confidence: 99%

“…A study of 119 769 donors from the US found a stronger impact, such that each unit increase in BMI among overweight and obese donors increased the risk of ESRD by 7% . In contrast, a single‐center study of 3752 predominantly white donors (1994‐2016) found that obesity increased the risk of PDDM 3‐fold but was not associated with ESRD ( P = .46) …”

Section: Introductionmentioning

confidence: 99%

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Associations of obesity with antidiabetic medication use after living kidney donation: An analysis of linked national registry and pharmacy fill records

Lentine

Koraishy

Sarabu

et al. 2019

Clinical Transplantation

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We examined a novel linkage of national US donor registry data with records from a pharmacy claims warehouse (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) to examine associations (adjusted hazard ratio, LCL aHR UCL ) of post-donation fills of antidiabetic medications (ADM, insulin or non-insulin agents) with body mass index (BMI) at donation and other demographic and clinical factors. In 28 515 living kidney donors (LKDs), incidence of ADM use at 9 years rose in a graded manner with higher baseline BMI: underweight, 0.9%; normal weight, 2.1%; overweight, 3.5%; obese, 8.5%. Obesity was associated with higher risk of ADM use compared with normal BMI (aHR, 3.36 4.59 6.27 ). Metformin was the most commonly used ADM and was filled more often by obese than by normal weight donors (9-year incidence, 6.87% vs 1.85%, aHR, 3.55 5.00 7.04 ). Insulin use was uncommon and did not differ significantly by BMI. Among a subgroup with BMI data at the 1-year post-donation anniversary (n = 19 528), compared with stable BMI, BMI increase >0.5 kg/m 2 by year 1 was associated with increased risk of subsequent ADM use (aHR, 1.03 1.48 2.14, P = .04). While this study did not assess the impact of donation on the development of obesity, these data support that among LKD, obesity is a strong correlate of ADM use.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Associations of obesity with antidiabetic medication use after living kidney donation: An analysis of linked national registry and pharmacy fill records

Lentine

Koraishy

Sarabu

et al. 2019

Clinical Transplantation

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“…In a single centre study of 3752 living kidney donors who underwent nephrectomy between 1975 and 2014, 656 (17.5%) were obese with a BMI ≥ 30 kg/m 2 [50]. Obese donors were more likely to be older, to be black and to have a higher eGFR at donation.…”

Section: Obese Donorsmentioning

confidence: 99%

One size does not fit all: understanding individual living kidney donor risk

Asgari

Hilton

2020

Pediatr Nephrol

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Living donor kidney transplantation is the optimal treatment for end-stage kidney disease (ESKD) but confers a risk upon the donor, both in the short term and many years after donation. While perioperative mortality is low and longevity does not appear to be adversely affected, there are small increases in the risk of other important morbidities. The overall risk of ESKD among donors is low but appears to be three-to five-fold higher than among healthy non-donors, and this relative risk is even higher among donors of African ancestry. For these individuals, apolipoprotein L1 genotyping may be helpful. Kidney donors also have an increased risk of developing hypertension post-donation and a modestly increased risk of developing gout. Living kidney donation also increases the risk of gestational hypertension and preeclampsia while not affecting other important pregnancy outcomes. As our understanding of donor risk grows, it is important to counsel prospective donors according to their individual risk and so obtain better informed donor consent. As knowledge advances, it is also important that all clinicians who manage kidney transplant candidates have an up to date understanding of donor risk to inform shared decision making.

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“…Of greater importance is the issue of counseling and mitigating risk. For example, obese living donors have increased risk for type 2 diabetes and hypertension postdonation that could aggravate any underlying obesity‐related glomerulopathy . Importantly, we must also not overlook those who lose weight to donate, as 73% will regain that weight within a year post‐transplant (51% weighing more than predonation) .…”

mentioning

confidence: 99%

Should donor body mass index influence kidney utilization by transplant centers?

Sharif

2019

Transpl Int

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Implications of excess weight on kidney donation: Long-term consequences of donor nephrectomy in obese donors

Cited by 33 publications

References 28 publications

Associations of obesity with antidiabetic medication use after living kidney donation: An analysis of linked national registry and pharmacy fill records

Associations of obesity with antidiabetic medication use after living kidney donation: An analysis of linked national registry and pharmacy fill records

One size does not fit all: understanding individual living kidney donor risk

Should donor body mass index influence kidney utilization by transplant centers?

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