A prospective study of living kidney donors: 6 years follow-up from a cardiovascular disease risk perspective

Mese, Meral; Ari, Elif

doi:10.1590/1806-9282.20220143

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 68 (8) • Aug 2022 • https://doi.org/10.1590/1806-9282.20220143 copy

A prospective study of living kidney donors: 6 years follow-up from a cardiovascular disease risk perspective

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The purpose of this prospective study was to evaluate the clinical, laboratory, and donation-specific outcomes of living kidney donors 6 years after donation.

METHODS:

We included a total of 93 kidney donors and 54 age- and sex-matched individuals as control group through a type 2 cohort consecutive recruitment. We detected kidney function abnormalities and the presence of hypertension, diabetes, and cardiovascular events during the 6 years follow-up period.

RESULTS:

The mean serum creatinine levels were higher (p<0.001), and the estimated glomerular filtration rate levels were lower (p<0.001) in living kidney donors 6 years after donation when compared with controls. The protein/creatinine ratio of the study population was also higher (p=0.014). There was no difference in outcomes between the groups for end-stage kidney disease and cardiovascular mortality. A higher rate of new-onset hypertension (6.4 vs. 32.9%), diabetes mellitus (0.0 vs. 4.3%), chronic kidney disease (0.0 vs. 2.1%), and cardiovascular disease (0.0 vs. 2.1%) was demonstrated among donors 6 years after donation (p<0.001, respectively).

CONCLUSION:

Our data have demonstrated that the reduction in Glomerular filtration rate induced by kidney donation might cause an increase in adverse renal and cardiovascular events.

KEYWORDS:
Living donors; Hypertension; Cardiovascular Abnormalities; Diabetes Mellitus

	Kidney donors (n=93)	Controls (n=53)	p-value
Age, years	53.37 [27–68]	55.44 [28–68]	0.403
Gender (male/female), n (%)	34 (37)/58 (63)	26 (49)/27 (51)	0.278
Body mass index, kg/m²2 Süleymanlar G, Ateş K, Seyahi N, Koçyiğit İ. Türkiye'de Nefroloji, Diyaliz ve Transplantasyon. Turkish J Nephrol. 2022;31:103-9. https://doi.org/10.5152/turkjnephrol.2022.22308 https://doi.org/10.5152/turkjnephrol.202...	26.5 [17.9–34.4]	27.3 [17.1–38.7]	0.594
Waist circumference, cm	98 [73–131]	93 [77–143]	0.378
Hypertension (yes/no), n (%)	6 (6.4)/87 (93.5)	4(7.6)/49(92.4)
Diabetes mellitus, n (%)	NA	NA	NA
Coronary artery disease	NA	NA	NA

	Kidney donors at donation(n=93)	Kidney donors 6 years after donation(n=93)	Controls at baseline(n=54)	Controls after 6 years(n=54)	p-value
Urea (mg/dL)	27.50 [23.00–33.00]	35.00 [29.00–39.00]	28.00 [24.00–33.25]	27.00 [22.00–32.30]	<0.001 ^* * Kidney donors 6 years after donation vs. controls after 6 years.
Creatinine (mg/dL)	0.75 [0.65–0.84]	0.93 [0.80–1.80]	0.67 [0.59–0.74]	0.70 [0.62–0.80]	<0.001 ^* * Kidney donors 6 years after donation vs. controls after 6 years.
GFR (mL/min/1.73 m²)	101.0 [92.58–109.36]	81.24 [67.36–88.62]	109.0 [101.75–117.0]	102.0 [94.9–109.1]	<0.001 ^* * Kidney donors 6 years after donation vs. controls after 6 years.
Albumin/creatinine (mg/g creatinine)	5.50 [3.00–10.00]	7.40 [3.70–15.50]	7.05 [4.95–14.43]	7.22 [5.04–14.40]	0.431
Protein/creatinine (mg/g creatinine)	85.20 [66.85–109.90]	85.52 [65.26–116.04]	67.93 [56.29–87.79]	67.94 [56.12–87.80]	0.014 ^* * Kidney donors 6 years after donation vs. controls after 6 years.
Hemoglobin (gr/dL)	13.45±1.70	13.61±1.57	13.60±1.48	13.87±1.51	0.325
Ferritin (ng/mL)	33.00 [14.25–59.79]	36.40 [19.90-64.90]	33.50 [14.65–81.95]	75.25 [31.40–112.70]	<0.001 ^* * Kidney donors 6 years after donation vs. controls after 6 years.
Total cholesterol (mg/dL)	198.10±45.68	186.38±38.45	209.69±46.86	165.66±34.67	0.094
LDL cholesterol (mg/dL)	120.00±31.76	122.28±47.90	134.53±45.74	123.88±34.12	0.868
Albumin (mg/dL)	5.69±9.59	4.26±0.27	4.34±0.23	4.47±0.25	0.165
Glucose (mg/dL)	95.00 [89.6–101.0]	92.00 [85.00–106.00]	98.00 [89.50–105.25]	95.00 [86.00–108.00]	0.508
HbA1c (%)	5.50 [5.20–5.70]	5.72 [5.48–6.96]	5.40 [5.30–5.70]	5.70 [5.60–5.90]	0.717
Uric acid (mg/dL)	5.04±1.21	5.62±1.18	4.53±0.81	4.43±0.99	<0.001 ^* * Kidney donors 6 years after donation vs. controls after 6 years.
PTH (pg/mL)	52.35 [40.7–67.72]	57.52 [40.70–76.55]	48.25 [35.58–68.63]	51.00 [36.80–65.30]	0.049 ^* * Kidney donors 6 years after donation vs. controls after 6 years.

	Kidney donors at donation (n=93)	Kidney donors 6 years after donation (n=93)	Controls at baseline (n=54)	Controls after 6 years(n=54)	p-value
Hypertension (n, %)	6 (6.4)	31 (32.9)	4 (7.6)	6 (11.1)	<0.001 ^* * Kidney donors at donation vs. 6 years after donation. Bold values indicate statistical significance at the p<0.05 level.
Diabetes mellitus (n, %)	NA	4 (4.3)	NA	1 (1.8)	<0.001 ^* * Kidney donors at donation vs. 6 years after donation. Bold values indicate statistical significance at the p<0.05 level.
Cardiovascular morbidity (n, %)	NA	2 (2.1)	NA	1 (1.8)	<0.001 ^* * Kidney donors at donation vs. 6 years after donation. Bold values indicate statistical significance at the p<0.05 level.
Cardiovascular mortality (n, %)	NA	NA	NA	NA	NA
Chronic kidney disease (n %)	NA	2 (2.1)	NA	NA	<0.001 ^* * Kidney donors at donation vs. 6 years after donation. Bold values indicate statistical significance at the p<0.05 level.
End-stage kidney disease (n %)	NA	NA	NA	NA	NA

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[1] *Corresponding author: mesemeral@gmail.com