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Author Topic: Hyperfiltration after donation and living kidney donor risk  (Read 437 times)

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Offline Clark

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Letter to the Editor

Hyperfiltration after donation and living kidney donor risk
M. van Londen*, J. van der Weijden and G. Navis
doi: 10.1111/ajt.14409

The editorial by Dr. Steiner states that follow-up on living kidney donors in all current studies
is too short for a good estimation of life-time End-Stage Renal Disease (ESRD) risks. We
agree that follow-up should be longer, in order to allow development of ESRD, but would
like to add an important additional argument for this statement. 
In the general population, the development of ESRD often is preceded by a period of CKD
with gradual renal function decline. But after living kidney donation, physiological
hyperfiltration occurs in which the kidney uses its renal reserve capacity. This process can
cause GFR increase for up to five years after donation(1). If a donor develops diabetic
nephropathy, glomerular hyperfiltration also occurs early in the disease, though through a
different mechanism(2). Finally, over the past decades, the mean BMI of the kidney donor
population has increased(3) and obesity-associated hyperfiltration is strongly associated with
ESRD risk on the long-term(4). These three causes of hyperfiltration cause an
underestimation of ESRD risk on the short-term and the latter two contribute to the
exponential risk on the long-term that dr. Steiner discusses. Studies with a follow-up below
ten years should take hyperfiltration into account when performing risk prediction.
Unrelated directed kidney donor in 2003, 58 gallon blood & platelet donor and counting!
Rep to the OPTN/UNOS Boards of Directors & Executive, Kidney Transplantation, & Ad Hoc Public Solicitation of Organ Donors Committees 2005-2011


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