Demographic, Metabolic, and Blood Pressure Characteristics of Living Kidney Donors Spanning Five Decades

Abstract Background and Aims Chronic kidney disease (CKD) is a highly prevalent risk factor for cardiovascular disease with an inverse relationship between estimated glomerular filtration rate (eGFR) and increases in all-cause and cardiovascular mortality. Living kidney donation provides a model to study the cardiovascular effects of a reduced kidney function in previously healthy subjects without comorbidities. We report follow up results in a group of kidney donors and healthy controls who underwent cardiovascular assessment at baseline, 12 months and 5 years after nephrectomy in the CRIB-DONOR studies (NCT01028703, NCT02973607). Method A longitudinal blinded end point study of kidney donors (n=50) and healthy controls (n=45) followed up between May 2017 to May 2019. Participants underwent a cardiac MRI (3.0 Tesla) for assessment of left ventricular (LV) size, mass, systolic function (ejection fraction and 3-dimensional feature tracking) and aortic distensibility. Clinical assessment included; office and 24-hr ambulatory blood pressure measures, measurement of arterial stiffness (SphygmoCor) and blood and urine analysis. Results Mean follow up time was 5.7 ± 0.7 yrs. Mean eGFR in donors was 95 ± 15 ml/min/1.73m2 prior to donation, 65 ±13ml/min/1.73m2 at 12 months and 67 ± 14 ml/min/1.73m2 at 5 years. This compared with an annual decline in eGFR of -1ml/min/1.73m2 in healthy controls. Despite a rise in LV mass at 12 months in the original study, by 5 years, LV mass in donors was no different to controls (113 ± 31g vs. 115 ± 30g, p=0.707). There was also no significant difference in LV volumes or LV geometry. At 5 years, 3D global longitudinal strain (donors -16.2 ± 2.5% vs. controls -14.9 ± 2.1%, p=0.007) and 3D global circumferential strain (donors -19.0 ± 2.5% vs. controls -17.7 ± 2.2%, p=0.004) were marginally greater in donors than controls. Markers of vascular stiffness (pulse wave velocity and augmentation index) were increased in donors compared to controls at 12 months but at 5 years they were not significantly different. No changes in office or ambulatory blood pressure were observed at any time point in donors or controls. At 5 years, uric acid was significantly greater in donors than controls (335 ± 83 µmol/L vs. 276 ± 7, p=<0.001) and had increased after the 12 month time point despite an improvement in eGFR. At 12 months the prevalence of a detectable troponin and levels of fibroblast growth factor-23 were greater in donors compared to controls, but this effect was lost at 5 years Conclusion The reduction in eGFR associated with nephrectomy in living kidney donors in the absence of intrinsic renal disease or comorbidity does not lead to adverse changes in cardiovascular structure and function at 5 years. This study offers reassurance to living kidney donors and the transplant community but should prompt further work into the causes of cardiovascular disease in CKD as we have found no medium term deleterious cardiovascular effects of an isolated reduction in eGFR.

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SP131WEIGHT GAIN AND OFFICE BLOOD PRESSURE IN LIVING KIDNEY DONORS: A FIVE YEAR FOLLOW UP STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz103.sp131 ◽

2019 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Anna Price ◽

Manvir Hayer ◽

Ashwin Radhakrishnan ◽

Luke Pickup ◽

William Moody ◽

...

Keyword(s):

Blood Pressure ◽

Office Blood Pressure ◽

Kidney Donors ◽

Living Kidney Donors ◽

Follow Up Study

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Blood pressure is increased in living kidney donors

Nature Clinical Practice Nephrology ◽

10.1038/ncpneph0295 ◽

2006 ◽

Vol 2 (11) ◽

pp. 604-604

Keyword(s):

Blood Pressure ◽

Kidney Donors ◽

Living Kidney Donors

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Ambulatory blood pressure monitoring in living kidney donors: What changes in 10 years?

Clinical Transplantation ◽

10.1111/ctr.13224 ◽

2018 ◽

Vol 32 (4) ◽

pp. e13224 ◽

Cited By ~ 2

Author(s):

Serkan Feyyaz Yalin ◽

Sinan Trabulus ◽

Nurhan Seyahi ◽

Mahir Cengiz ◽

Mustafa Erdogan Cicik ◽

...

Keyword(s):

Blood Pressure ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Pressure Monitoring ◽

Kidney Donors ◽

Living Kidney Donors

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Diagnostic Performance of Blood Pressure Measurement Modalities in Living Kidney Donor Candidates

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.02780218 ◽

2019 ◽

Vol 14 (5) ◽

pp. 738-746 ◽

Cited By ~ 1

Author(s):

Sherif Armanyous ◽

Yasushi Ohashi ◽

Michael Lioudis ◽

Jesse D. Schold ◽

George Thomas ◽

...

Keyword(s):

Blood Pressure ◽

Gold Standard ◽

False Negative ◽

Youden Index ◽

Equal Weight ◽

Masked Hypertension ◽

Kidney Donors ◽

Gold Standard Method ◽

Predictive Values ◽

Living Kidney Donors

Background and objectivesPrecise BP measurement to exclude hypertension is critical in evaluating potential living kidney donors. Ambulatory BP monitoring is considered the gold standard method for diagnosing hypertension, but it is cumbersome to perform. We sought to determine whether lower BP cutoffs using office and automated BP would reduce the rate of missed hypertension in potential living donors.Design, setting, participants, & measurementsWe measured BP in 578 prospective donors using three modalities: (1) single office BP, (2) office automated BP (average of five consecutive automated readings separated by 1 minute), and (3) ambulatory BP. Daytime ambulatory BP was considered the gold standard for diagnosing hypertension. We assessed both the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology/American Heart Association (ACC/AHA) definitions of hypertension in the cohort. Empirical thresholds of office BP and automated BP for the detection of ambulatory BP–diagnosed hypertension were derived using Youden index, which maximizes the sum of sensitivity and specificity and gives equal weight to false positive and false negative values.ResultsHypertension was diagnosed in 90 (16%) prospective donors by JNC-7 criteria and 198 (34%) prospective donors by ACC/AHA criteria. Masked hypertension was found in 3% of the total cohort by JNC-7 using the combination of office or automated BP, and it was seen in 24% by ACC/AHA guidelines. Using Youden index, cutoffs were derived for both office and automated BP using JNC-7 (<123/82 and <120/78 mm Hg) and ACC/AHA (<119/79 and <116/76 mm Hg) definitions. Using these lower cutoffs, the sensitivity for detecting hypertension improved from 79% to 87% for JNC-7 and from 32% to 87% by ACC/AHA definition, with negative predictive values of 95% and 87%, respectively. Missed (masked) hypertension was reduced to 2% and 4% of the entire cohort by JNC-7and ACC/AHA, respectively.ConclusionsThe prevalence of hypertension was higher in living donor candidates using ACC/AHA compared JNC-7 definitions. Lower BP cutoffs in the clinic improved sensitivity and led to a low overall prevalence of missed hypertension in prospective living kidney donors.

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