Living kidney donor evaluation for all candidates with normal estimated GFR for age

Jacquemont, Lola; Lazareth, Hélène; Albano, Laetitia; Barrou, B.; Bouvier, Nicolas; Büchler, Mathias; Titeca-Beauport, Dimitri; Couzi, Lionel; Ducloux, Didier; Étienne, Isabelle; Frimat, Luc; Garrouste, Cyril; Glotz, Denis; Grimbert, Philippe; Hazzan, Marc; Hertig, Alexandre; Hourmant, Maryvonne; Kamar, Nassim; Meur, Yann Le; Quintrec, Moglie Le; Legendre, Christophe; Moal, Valérie; Moulin, Anne‐Marie; Mousson, Christiane; Pouteil‐Noble, Claire; Rieu, Philippe; Ouali, Nacéra; Rostaing, Lionel; Thierry, Antoine; Touré, Fatouma; Chemouny, Jonathan; Delanaye, Pierre; Courbebaisse, Marie; Mariat, Christophe

doi:10.1111/tri.13870

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…Therefore, CT measurement of KD can improve the accuracy of GFR calculations. This is especially true for living kidney transplant donors who need accurate renal GFR partitioning (17,18).…”

Section: Discussionmentioning

confidence: 99%

Establishment of a formula for the estimation of kidney depth in adults and its effect on glomerular filtration rate assessment

Liu¹,

Wang²,

Xie³

et al. 2022

Transl Androl Urol

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Background: Gates' analysis method for kidney depth (KD) calculation is the only way to determine the glomerular filtration rate (GFR) of the kidney in clinical practice, which posits that the influence of KD on the GFR is more important than other factors. Computed tomography (CT) measurement of the donor KD can improve the accuracy of GFR measurement by Gates' method but will also increase the radiation exposure of kidney transplantation donors. Thus, it is particularly important to establish an accurate empirical formula for KD measurement that is more consistent with the real KD.Methods: In total, 326 potential renal transplantation donors were enrolled in this study. Among these, 167 donors were assigned to the training set to estimate the regression formula of KD measured by CT. The remaining 159 donors were included in the validation set to verify the regression formula. The KD measured by CT and its corresponding GFR was taken as the reference standard. The performances of formulas were then compared.Results: There was no significant statistical difference between the CT-measured KD and the current fitting, Li Q, and Xue JJ formulas (P>0.05). However, significant differences were observed between the KDs calculated using the Taylor, Ma G, and Uchiyama formulas and the CT-measured reference standard KD (P<0.05). Furthermore, there was no notable difference in the GFR L and GFR R corresponding to the CT-measured KD with that of the fitting, Ma G, and Xue JJ formulas (P>0.05). There were also marked differences in the GFR R corresponding to the Li Q's formula (P<0.05), and in the GFR between other estimation methods and the CT measurement (P<0.05). Conclusions:The fitting formula established in this study can play a more important role if an accurate measurement method of the body thickness at the level of the hilum on the body surface can be found.

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“…Therefore, CT measurement of KD can improve the accuracy of GFR calculations. This is especially true for living kidney transplant donors who need accurate renal GFR partitioning (17,18).…”

Section: Discussionmentioning

confidence: 99%

Establishment of a formula for the estimation of kidney depth in adults and its effect on glomerular filtration rate assessment

Liu¹,

Wang²,

Xie³

et al. 2022

Transl Androl Urol

View full text Add to dashboard Cite

show abstract

“…Finally, Gaillard et al (82) in 2021 studied 1,825 French LKDs. After a mean follow-up of almost 6 years, they found that in donors younger than 45 years post-donation eGFR, absoluteand relative-eGFR variation were not different among the three groups, normal for age (Sage), higher than 90 (S90), or 80(S80) ml/min/1.73 m 2 .…”

Section: Renal Function After Donationmentioning

confidence: 99%

Assessing Renal Function for Kidney Donation. How Low Is Too Low?

2022

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Kidney transplantation (KT) is the treatment of choice for patients with end-stage kidney disease (ESKD) with decreased morbi-mortality, improved life quality, and reduced cost. However, the shortage of organs from deceased donors led to an increase in KT from living donors. Some stipulate that living donors have a higher risk of ESKD after donation compared with healthy non-donors. The reason for this is not clear. It is possible that ESKD is due to the nephrectomy-related reduction in glomerular filtration rate (GFR), followed by an age-related decline that may be more rapid in related donors. It is essential to assess donors properly to avoid rejecting suitable ones and not accepting those with a higher risk of ESKD. GFR is a central aspect of the evaluation of potential donors since there is an association between low GFR and ESKD. The methods for assessing GFR are in continuous debate, and the kidney function thresholds for accepting a donor may vary according to the guidelines. While direct measurements of GFR (mGFR) provide the most accurate evaluation of kidney function, guidelines do not systematically use this measurement as a reference. Also, some studies have shown that the GFR decreases with age and may vary with gender and race, therefore, the lower limit of GFR in patients eligible to donate may vary based on these demographic factors. Finally, it is known that CrCl overestimates mGFR while eGFR underestimates it, therefore, another way to have a reliable GFR could be the combination of two measurement methods.

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End-proximal tubule phosphate concentration increases as GFR falls in humans: measurement by means of a lithium clearance-based methodology

Colussi

Menegotto

Querques

et al. 2022

Nephrology Dialysis Transplantation

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Background Microscopic nephrocalcinosis secondary to intratubular CaP precipitation is thought to accelerate progression to end-stage renal failure in chronic kidney diseases. In P-loaded uninephrectomized rats intratubular CaP crystal formation and progressive tubular damage occurred when end-proximal tubule P concentration (ePTpc) increased above a threshold level. Methods We have calculated ePTpc in humans by urine P and creatinine concentration, with the end-proximal tubule fluid volume calculated either as Li clearance (ePTpc-Li) or as a fixed 0.7 fraction of GFR, as published (ePTpc-70). Healthy people undergoing living transplant kidney donation before (DON-pre, n = 70) and after (DON-post, n = 64) nephrectomy, and 25 patients with stage 2–5 CKD, were investigated while on regular free diet. Results ePTpc showed a stepwise increase with decreasing functional renal mass (DON-pre 2.51 ± 0.99 and 1.56 ± 0.47mg/dl for -Li and -70 calculation, respectively; DON-post 3.43 ± 1.14 and 2.18 ± 0.44; CKD 5.68 ± 3.30 and 3.00 ± 1.30, <0.001 for all); ePTpc was inversely correlated with Ccr and directly with PTH, fractional P excretion and P excretion corrected for GFR (p < 0.001 for all), but not with Pp. ePTpc-Li and ePTpc-70 were significantly correlated (r = 0.62, p < 0.001), but ePTpc-70 was lower than corresponding ePTpc-Li. Levels of ePTpc increased above a suggested dangerous threshold when daily UpV/GFR was higher than about 10 mg/mlCcr. Conclusions ePTpc progressively increases in humans as functional renal mass falls independently from plasma P levels. Main determinants of ePTpc rise are GFR fall, degree of phosphaturia per unit GFR, and P intake corrected for GFR. It may become a novel, potentially useful, indicator to guide management of CKD patients.

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Living kidney donor evaluation for all candidates with normal estimated GFR for age

Cited by 3 publications

References 27 publications

Establishment of a formula for the estimation of kidney depth in adults and its effect on glomerular filtration rate assessment

Establishment of a formula for the estimation of kidney depth in adults and its effect on glomerular filtration rate assessment

Assessing Renal Function for Kidney Donation. How Low Is Too Low?

End-proximal tubule phosphate concentration increases as GFR falls in humans: measurement by means of a lithium clearance-based methodology

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