Living Donor Kidney Donation: Another Form of White Coat Effect

DeLoach, Stephanie; Meyers, Kevin; Townsend, Raymond R.

doi:10.1159/000335070

Cited by 15 publications

(7 citation statements)

References 23 publications

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“…Markers of endothelial function and bone metabolism demonstrated significant changes related to the decline in GFR while the inflammatory markers showed no significant changes. Mean DBP remained unchanged, while mean SBP was significantly lower at 6 months post donation as we reported previously [10]. The changes in eGFR we observed are similar to those recently reported by Kasiske et al 6 months post-donation [17].…”

Section: Discussionsupporting

confidence: 90%

“…With long term follow-up, living kidney donors have shown loss of circadian blood pressure rhythm on ambulatory blood pressure monitoring despite maintaining normotensive status [9]. However, when this loss of circadian rhythm occurs is not precisely established and our recent data found no significant changes in blood pressure and the blood pressure circadian rhythm at 6 months post donation by ambulatory blood pressure monitoring (ABPM) [10]. …”

Section: Introductionmentioning

confidence: 99%

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Changes in Biomarkers Associated with Living Kidney Donation

et al. 2013

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Living donor kidneys have been associated with better graft and overall survival in kidney transplant recipients. Although a living kidney donation is generally considered safe in carefully selected living donors, concerns of possible adverse effects related to kidney donation remain, especially in younger and high-risk donors. In this study, we examined the changes in a panel of traditional and novel serum biomarkers linked with cardiovascular conditions in a cohort of 34 healthy living kidney donors with a mean age ± SD of 40 ± 10 years and estimated predonation glomerular filtration rate (GFR) of 86 ± 10 ml/min/1.73 m². At 6 months after donation, there were no significant changes in the clinical parameters including body mass index and blood pressure despite a significant decline in the mean estimated GFR to 60 ml/min/1.73 m². Among the panel of markers, the levels of symmetric dimethylarginine and fibroblast growth factor 23 increased significantly compared to baseline, suggesting that living kidney donation may result in changes in biomarkers that are associated with cardiovascular risk in other cohorts.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Changes in Biomarkers Associated with Living Kidney Donation

et al. 2013

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“…On the contrary, hypertensive blood pressure readings without confirmation by 24 h blood pressure recording may reflect white coat hypertension. 30 31 In our study, all new diagnoses of hypertension had to be verified by 24 h ambulatory blood pressure recording. Blood pressure values in the normal range were only accepted as ‘normal’ if a list of drugs taken the same day was reported to SOL-DHR.…”

Section: Discussionmentioning

confidence: 99%

Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors

et al. 2016

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ObjectivesTo assess the role of nephrectomy as a risk factor for the development of hypertension and microalbuminuria.DesignProspective, long-term follow-up study.SettingSwiss Organ Living-Donor Health Registry.ParticipantsAll living kidney donors in Switzerland between 1993 and 2009.InterventionsData on health status and renal function before 1 year and biennially after donation were collected.Primary and secondary outcome measuresComparison of 1-year and 5-year occurrences of hypertension among normotensive donors with 1-year and 5-year estimates from the Framingham hypertension risk score. Multivariate random intercept models were used to investigate changes of albumin excretion after donation, correcting for repeated measurements and cofactors such as age, male gender and body mass index.ResultsA total of 1214 donors contributed 3918 data entries with a completed biennial follow-up rate of 74% during a 10-year period. Mean (SD) follow-up of donors was 31.6 months (34.4). Median age at donation was 50.5 years (IQR 42.2–58.8); 806 donors (66.4%) were women. Donation increased the risk of hypertension after 1 year by 3.64 (95% CI 3.52 to 3.76; p<0.001). Those participants remaining normotensive 1 year after donation return to a risk similar to that of the healthy Framingham population. Microalbuminuria before donation was dependent on donor age but not on the presence of hypertension. After nephrectomy, hypertension became the main driver for changes in albumin excretion (OR 1.19; 95% CI 0.13 to 2.25; p=0.03) and donor age had no effect.ConclusionsNephrectomy propagates hypertension and increases susceptibility for the development of hypertension-induced microalbuminuria.

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“…A recent small study of 17 donors showed remarkable differences between clinic systolic blood pressure and ambulatory systolic blood pressure prior to donation. These differences disappeared 6 months after donation, suggesting a substantial white-coat effect on systolic blood pressure associated with living kidney donor evaluation (44).…”

Section: Hypertensionmentioning

confidence: 98%

Evaluation of high-risk living kidney donors

Mandelbrot¹

2015

Front Biosci

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Careful evaluation of potential living kidney donors is crucial to assure the well being of the donors, especially because they do not gain any direct medical benefit from donation. This process also helps assess the quality and safety of the organs donated to the recipients. While all programs share these goals, donor selection criteria vary significantly among U.S. transplant centers. In part, this is due to the limited data that exists as to longterm outcomes among donors who are medically complex, or at higher risk for complications, such as those with hypertension, obesity, or lower kidney function. This article reviews available evidence regarding outcomes after living donation and current trends in U.S. practices, and seeks to provide practical guidance in evaluating high-risk potential living kidney donors.

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Living Donor Kidney Donation: Another Form of White Coat Effect

Cited by 15 publications

References 23 publications

Changes in Biomarkers Associated with Living Kidney Donation

Changes in Biomarkers Associated with Living Kidney Donation

Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors

Evaluation of high-risk living kidney donors

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