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Predictive factors of glomerular filtration rate loss associated with living kidney donation: a single-center retrospective study

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Abstract

Purpose

Living kidney donors (LKD) partially compensate the initial loss of glomerular filtration rate (GFR), a phenomenon known as renal functional reserve (RFR). RFR is reduced in the elderly, a population with increased prevalence of chronic kidney disease. We hypothesized that the selected, healthy population of LKD, would specifically inform about the physiological determinants of the RFR and studied it using measured GFR (mGFR).

Methods

We retrospectively analyzed pre-donation and post-donation mGFR in 76 LKD from Tenon Hospital (Paris, France) between 2002 and 2018. In addition to GFR measurements, we collected pre-donation morphologic parameters, demographic data, and kidney volumes.

Results

Mean pre-donation mGFR was 90.11 ± 12.64 mL/min/1.73 m2 and decreased to 61.26 ± 9.57 mL/min/1.73 m2 1 year after donation. Pre-donation mGFR correlated with age (p = 0.0003), total kidney volume (p = 0.0004) and pre-donation serum creatinine (p = 0.0453). Pre-donation mGFR strongly predicted 1-year post-donation mGFR. Mean RFR (increase in GFR of the remnant kidney between pre-donation and post-donation) was 36.67 ± 16.67% 1 year after donation. In the multivariate linear model, RFR was negatively correlated to total kidney volume (p = 0.02) but not with age or pre-donation serum creatinine.

Conclusions

We found that pre-donation mGFR decreases with age and identified low total kidney volume as a predictor of RFR in healthy individuals. This suggests an adaptative and reversible decrease in kidney function rather than age-related damage. Older subjects may have reduced metabolic requirements with subsequent reduction in glomerular filtration and kidney volume and preserved RFR. Therefore, low GFR in older subjects should not preclude kidney donation.

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Abbreviations

BMI:

Body mass index

BSA:

Body surface area

CKD-Epi:

Chronic kidney disease-epidemiology collaboration

CKD:

Chronic kidney disease

CT:

Computerized tomography

eGFR:

Estimated glomerular filtration rate

ESRD:

End-stage renal disease

GFR:

Glomerular filtration rate

IQR:

Interquartile range

LKD:

Living kidney donors

mGFR:

Measured glomerular filtration rate

RFR:

Renal functional reserve

SD:

Standard deviation

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Funding

Pierre Galichon was supported by a grant from ATIP-Avenir 2019.

Author information

Author notes

  1. Arthur Orieux, Antonin Bouchet and Alice Doreille contributed equally.

Authors and Affiliations

  1. Sorbonne Universite, UMR_S 1155, INSERM, Tenon Hospital, Paris, France

    Arthur Orieux, Marine Livrozet, Jean-Philippe Haymann, Laurent Mesnard, Emmanuel Letavernier & Pierre Galichon

  2. Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Sorbonne Universite, Paris, France

    Antonin Bouchet, Alice Doreille, Nacera Ouali, Laurent Mesnard & Pierre Galichon

  3. Claude Bernard University Lyon I, Lyon, France

    Antonin Bouchet

  4. Department of Radiology, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Sorbonne Universite, Paris, France

    Liliana Paslaru

  5. Department of Physiology, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Sorbonne Universite, Paris, France

    Marine Livrozet, Jean-Philippe Haymann & Emmanuel Letavernier

Authors
  1. Arthur Orieux
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  2. Antonin Bouchet
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  3. Alice Doreille
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  4. Liliana Paslaru
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  5. Marine Livrozet
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  6. Jean-Philippe Haymann
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  7. Nacera Ouali
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  8. Laurent Mesnard
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  9. Emmanuel Letavernier
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  10. Pierre Galichon
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Contributions

Conceptualization and methodology: AO, AB, ML, PG. Data acquisition: AB, AD, ML, PG, LP, NO, EL. Data interpretation: AO, AB, ML, PG. Writing—original draft: AO, AB, PG. Writing—review and editing: AO, AB, AD, ML, JH, EL, LM, PG.

Corresponding author

Correspondence to Pierre Galichon.

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Conflict of interest

The authors declared that there is no conflict of interest.

Ethical approval

Our retrospective study was conducted solely on already available data. In compliance with the French legislation, this research does not involve a human person, thus neither formal consent nor approval by an institutional review board is needed (Jardé Act and Law No. 78-17 of 6 January 1978 relating to computers, files and freedoms).

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Orieux, A., Bouchet, A., Doreille, A. et al. Predictive factors of glomerular filtration rate loss associated with living kidney donation: a single-center retrospective study. World J Urol 40, 2161–2168 (2022). https://doi.org/10.1007/s00345-022-04019-x

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  • DOI: https://doi.org/10.1007/s00345-022-04019-x

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