Living Kidney Donors Face Large Risk for CKD

[livingdonor101]

http://www.renalandurologynews.com/living-kidney-donors-face-large-risk-for-ckd/article/198730/

VIENNA—One year after undergoing living donor nephrectomy (LDN), more than half of donors will have chronic kidney disease (CKD), according to a British study. Their decline in renal function, however, appears to remain stable for at least five years and patients rarely suffer adverse cardiovascular events and cardiac mortality. 

In the study, a team led by Nilay S. Patel, MD, a urology resident at The Churchill Hospital, examined data from 3,424 patients who underwent LDN in the United Kingdom and had preoperative and one-year follow-up data available. Complete post-operative follow-up data were available up to year 5 for 784 patients.

At one year, LDN was associated with an increase in mean serum creatinine level from 83 to 112 umol/L, Dr. Patel reported at the 26th Annual Congress of the European Association of Urology. This translated into a reduction in mean glomerular filtration rate (GFR) from 100 to 59 mL/min/1.73 m2. At one year, 53% of patients could be classified as having CKD stage 3-4. Mean GFR, however, did not change significantly between year 1 and year 5, said Dr. Patel, who presented study findings.

“The fall in GFR [following LDN] has been underestimated to date,” said Dr. Pitel, who noted that individuals wishing to donate a kidney will need to be informed of the latest data on renal function decline following LDN.

In patients with five years of follow-up, non-fatal cardiac events and cardiac mortality were reported in 0.4% and 0.05% of patients. New onset hypertension was diagnosed in 10% of subjects.

[livingdonor101]

Since they only followed the LKDs for five years, it's a bit premature to say there are no adverse cardiovascular events. In that short time period, sure, but ten, fifteen, twenty years with CKD and the results could be different.

[Sarah in Maine]

Thanks for the post. I find it particularly interesting in light of the study posted in the general forum by Bill Freeman (yesterday, I think) about different ways of measuring GFR.  Just from your summary, it appears that the "CKD" that this British study is highlighting is based on the GFR number rather than, necessarily, actual chronic disease of the donor's remaining kidney.  I don't mean to underestimate the medial results that the donor's filtration rate does change, but use of the word "disease" can be misleading.  Of course you are absolutely correct that we need more long-term studies of the myriad possible health consequences of donation -- creatinine levels, heart disease, etc. 

[Karol]

How can information vary so?
I just posted another news article "Live Kidney Donors Experience GFR Increases" https://livingdonorsonline.org/ldosmf/index.php?topic=143.0

[WilliamLFreeman]

Karol & y'all,
   Here is my explanation.  Renal and Urology News is a newspaper, not a peer-reviewed journal.  We readers do not not know if the reporter's report accurately states what the Patel reported.  And Patel's findings have not been published in a peer-reviewed journal.  Please see my 2 replies to Karol's other post.

Christy & Sarah & y'all,
   Until I see the peer-reviewed article, I do not know how valid the newspaper article is.  One thing for sure, though, as Sarah points out:  one major flaw may be the assumption that the standards, and GFR-defined groups ["CKD Stage 3"] in the CKD classification apply to to living kidney donors [LKDs].  Those standards and cut-offs are based on a study of the mortality of less than 2,000 people with 2 kidneys and also known kidney disease.  Do those standards and curt-offs apply to LKDs?  Do LKDs experience the same mortality rates as people do with the same GFR value who have 2 kidneys and also kidney disease?  No-one knows, because a similar study has not been done among just LKDs.
   Patel's study, as with the study Karol reported, may be most valuable in indicating that the LKDs' GFRs did not decline faster over the 5 years than do other people's GFRs with 2 kidneys.  Neverthless, even then, the study is "observational," and thus is not definitive.  (See my 2nd post to Karol's report.)

I "can't wait" until the results of the controlled clinical trial of LKD vs. no LKD are reported -- 2-3 years, I think.

Bill

[Donna Luebke]

Bill,

Qestion about your last statement--which controlled clinical trial are you referring to because if this is RELIVE, this is not a long term study. There are none.  As for peer-reviewed, this alone does not indicate the article is reliable or of quality as those published in transplant journals about live donors are suspect especially if using UNOS database and are spun out saying donors are fine and living donors do not have long-term issues.  There have never been any quality controls on the UNOS data.  I have asked directly and UNOS staffer could not give me any anwer as to what methods have been employed to very quality and accuracy since 1988--I was looking for something like the UK uses for accuracy of its living donor registry.  UNOS data is not reliable or comprehensive and small cohorts only give us a snapshot.  Again, we are not all created equal.  I volleyed emails with an SRTR data person.  His comment was 'anyone with one kidney has CKD.'  Our lone kidney is not normal.  Hyperfiltration and hypertrophy is not normal.  Ignoring that our kidney function is not the same once we lose 50% of our nephrons with donation, denies donors the long term vigilant monitoring and care we need (this is to the transplant community and not you, Bill--as you have done a great job here educating and supporting donors.)

Donna
Kidney donor, 1994

[livingdonor101]

Peer-reviewed hardly means without flaw or bias. One of my recent blog posts linked an article about a recent major case of medical research fraud, a site that follows published articles that are retracted, and an indepth examination of why 'most' (the author's word) published research studies are false -> http://sirencristy.blogspot.com/2011/03/fraud-in-medical-research.html

Connie Davis has even been known to - uh, fudge - a bit on her references, which I wrote about back in June. It's not as if I was looking to trip her up, I just happen to be a big fan of source material. -> http://sirencristy.blogspot.com/2010/06/unraveling-that-living-donor-death-rate.html

A small note on the UNOS data - in the latest spurt of public policies posted for public comment (wow on the alliteration), there's a bar chart on living donor followup forms submitted from July 1, 2007 thru June 30, 2008. 15 centers reported NOTHING on ANY of their living donors. Only approximately 50 managed to meet the 90% reporting threshold... Out of over 200 programs... When the policy went into effect in 2000.