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Does Low GFR Mean CKD in Living Kidney Donors?

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Michael:
I would be remiss if I didn't include a link to the classic LDO message thread on this topic started by the incomparable Dr. William Freeman. His first message was posted on March 19, 2011 and it is as relevant today as it was then. (And in some respects speaks to how little progress has been made in 12 years.)

https://livingdonorsonline.org/ldosmf/index.php?topic=141.msg392#msg392

Michael:
The Consequences of Chronic Kidney Disease Mislabeling in Living Kidney Donors
https://www.mayoclinicproceedings.org/article/S0025-6196(14)00330-9/fulltext


This 2014 article presents two cases of living kidney donors harmed by being characterized as having chronic kidney disease (CKD), despite being in good health. The authors note that mislabeling donors has having CKD can be traced to problems with the current methodology for determining CKD. One problem is that the system does not recognize that "the reduction in GFR associated with unilateral donor nephrectomy is not a progressive disease process and, unlike CKD, is not associated with an increased risk of end-stage renal disease (ESRD), adverse cardiovascular outcomes, or death when compared with the general population," citing five medical research papers to back up the observations about donor health. A second problem is that "the use of GFR estimation equations in living donors frequently results in underestimation of GFR" because the formulas were created to estimate GFR "in a population of binephric [two kidney] patients with true CKD (emphasis added)."

The authors note: "Improved education about the limitations of CKD estimation equations for both physicians and insurance companies may save healthy kidney donors the stress of being mislabeled with a disease. Changes in the CKD classification system itself would be welcome."

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