« on: June 27, 2017, 04:37:57 PM »
http://onlinelibrary.wiley.com/doi/10.1111/ajt.14409/epdfLetter to the EditorHyperfiltration 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 withESRD 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.
Logged
Unrelated directed kidney donor in 2003, recipient and I both well.
625 time blood and platelet donor since 1976 and still giving!
Elected to the OPTN/UNOS Boards of Directors & Executive, Kidney Transplantation, and Ad Hoc Public Solicitation of Organ Donors Committees, 2005-2011
Proud grandpa!