Risk-Assessment for Potential Live-Kidney Donors: Predicting eGFR

Background: One third of live kidney donors have long-term post-donation estimated glomerular filtration rate (eGFR) corresponding to Chronic Kidney Disease (CKD) stage 3. While their risk of CKD progression is low compared to other populations for the same eGFR, they require specific counseling, stricter monitoring and risk factor modification to avert CKD progression. Aim: To study pre-operative predictors for a 1-year post-donation eGFR falling within CKD stage 3 criteria. Methods: Retrospective review of 102 kidney donors between July 2010-July 2012 with complete 1 year follow up data. Baseline and 1-yr eGFR calculated with CKD-EPI equation. Renal volumes (RV) and eGFR adjusted to body surface area (BSA). Predictors of 1-yr eGFR<60 ml/min/1.73m2 assessed by multiple and logistic regression.Table: No Caption available.Results: Significantly associated independent predictors of 1-yr eGFR<60 were: Baseline eGFR (p=0.032) OR 3.624 [CL 1.11-1175] and donor age (p=0.002) OR 3.082 [CL 1.49-6.37] and their interaction (p=0.0051); Preserved RV (p=0.005), OR 2.362 [95% CL 1.29-4.32] for each decrease in 10 cc/BSA*1.73m2 in cohort range 108-225; Borderline BP pre-donation (p=0.020), OR 10.070 [95% CL 1.43-70.74]. Race, gender, metabolic Sme, BSA and BMI were not associated.Figure: No Caption available.Conclusion: In our study, risk of 1-yr eGFR <60 ml/min/1.73m2 greatly increased in donors with either age >46, baseline eGFR <99, abnormal pre-donation blood pressure and decreasing preserved RV. Live kidney-donors who fall into these categories can be identified pre-donation, should be monitored closely post-donation and counseled accordingly.