scholarly journals Fasting before living-kidney donation: effect on donor well-being and postoperative recovery: study protocol of a multicenter randomized controlled trial

Trials ◽  
2022 ◽  
Vol 23 (1) ◽  
Author(s):  
C. A. J. Oudmaijer ◽  
R. C. Minnee ◽  
R. A. Pol ◽  
W. M. C. van den Boogaard ◽  
D. S. J. Komninos ◽  
...  
Keyword(s):  
Caloric Restriction ◽  
Postoperative Recovery ◽  
Study Endpoint ◽  
Kidney Donation ◽  
Preoperative Fasting ◽  
Living Kidney Donation ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Link Type ◽  
Multicenter Randomized Controlled Trial

Abstract Background One of the main effectors on the quality of life of living-kidney donors is postoperative fatigue. Caloric restriction (CR) and short-term fasting (STF) are associated with improved fitness and increased resistance to acute stress. CR/STF increases the expression of cytoprotective genes, increases immunomodulation via increased anti-inflammatory cytokine production, and decreases the expression of pro-inflammatory markers. As such, nutritional preconditioning by CR or STF represents a non-invasive and cost-effective method that could mitigate the effects of acute surgery-induced stress and postoperative fatigue. To investigate whether preoperative STF contributes to a reduction in fatigue after living-kidney donation, a randomized clinical trial is indicated. Methods We aim to determine whether 2.5 days of fasting reduces postoperative fatigue score in subjects undergoing living-kidney donation. In this randomized study, the intervention group will follow a preoperative fasting regime for 2.5 days with a low-dose laxative, while the control group will receive standard care. The main study endpoint is postoperative fatigue, 4 weeks after living-kidney donation. Secondary endpoints include the effect of preoperative fasting on postoperative hospital admission time, the feasibility of STF, and the postoperative recovery of donor and recipient kidney function. This study will provide us with knowledge of the feasibility of STF and confirm its effect on postoperative recovery. Discussion Our study will provide clinically relevant information on the merits of caloric restriction for living-kidney donors and recipients. We expect to reduce the postoperative fatigue in living-kidney donors and improve the postoperative recovery of living-kidney recipients. It will provide evidence on the clinical merits and potential caveats of preoperative dietary interventions. Trial registration Netherlands Trial Register NL9262. EudraCT 2020-005445-16. MEC Erasmus MC MEC-2020-0778. CCMO NL74623.078.21

scholarly journals Physician Attitudes Toward Living Kidney Donation

2018 ◽  
Vol 29 (1) ◽  
pp. 78-83 ◽  
Author(s):  
Howard Trachtman ◽  
Brendan Parent ◽  
Ari Kirshenbaum ◽  
Arthur Caplan
Keyword(s):  
Internal Medicine ◽  
Careful Consideration ◽  
Physician Attitudes ◽  
Kidney Donation ◽  
Living Donation ◽  
Living Kidney Donation ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Kidney Donors ◽  
Living Kidney Donors

Background: Compared to dialysis, living kidney donation has a greater chance of restoring health and is associated with better outcomes than deceased kidney donation. Although physicians advocate for this treatment, it is uncertain how they would act as potential living kidney donors or recipients. Methods: We surveyed 104 physicians, pediatric, and internal medicine nephrologists, to ascertain their attitudes toward living donation. Results: Among surveyed nephrologists, there was nearly universal support for living kidney donation as a viable medical option, and nearly all of them would support a healthy and medically cleared patient who wishes to participate. Although support was still strong, nephrologists were significantly less likely to support their friends and relatives participating in living kidney donation, and their support declined further for friends and relatives donating to nonrelatives. Conclusion: Our findings suggest the need to more deeply examine physician-perceived risks involved in serving as a living kidney donor. Based on differences in surveyed nephrologist attitudes regarding donation to and from loved ones versus nonrelatives, we suggest that physicians should give careful consideration to how they describe the risks of living donation to potential donors.

The Risk in Living Kidney Donation

2017 ◽  
Vol 27 (1) ◽  
pp. 29-35
Author(s):  
WALTER GLANNON
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Lifetime Risk ◽  
Kidney Donation ◽  
Living Kidney Donation ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Closing The Gap ◽  
Stage Renal Disease ◽  
End Stage

Abstract:This article examines two questions. (1) If prospective living kidney donors knew of the lifetime risk of end-stage renal disease (ESRD) in their remaining kidney, then would they be as willing to give it up? and (2) What should transplant organizations and physicians be telling those who express an interest in donating a kidney about risk? Based on the principle that prospective donors must be fully informed of the risk, I raise the issue of a possible obstacle to closing the gap between the availability and need of transplantable kidneys. Some strategies are offered to address this problem.

scholarly journals Self-Reported Incident Hypertension and Long-Term Kidney Function in Living Kidney Donors Compared with Healthy Nondonors

2019 ◽  
Vol 14 (10) ◽  
pp. 1493-1499 ◽  
Author(s):  
Courtenay M. Holscher ◽  
Christine E. Haugen ◽  
Kyle R. Jackson ◽  
Jacqueline M. Garonzik Wang ◽  
Madeleine M. Waldram ◽  
...  
Keyword(s):  
Kidney Donation ◽  
Living Kidney Donation ◽  
Kidney Donors ◽  
Incident Hypertension ◽  
Living Kidney Donors ◽  
Parametric Survival Model ◽  
Yearly Change ◽  
Parametric Survival ◽  
Multilevel Linear Regression

Background and objectivesThe risk of hypertension attributable to living kidney donation remains unknown as does the effect of developing postdonation hypertension on subsequent eGFR. We sought to understand the association between living kidney donation, hypertension, and long-term eGFR by comparing donors with a cohort of healthy nondonors.Design, setting, participants, & measurementsWe compared 1295 living kidney donors with median 6 years of follow-up with a weighted cohort of 8233 healthy nondonors. We quantified the risk of self-reported hypertension using a parametric survival model. We examined the association of hypertension with yearly change in eGFR using multilevel linear regression and clustering by participant, with an interaction term for race.ResultsKidney donation was independently associated with a 19% higher risk of hypertension (adjusted hazard ratio, 1.19; 95% confidence interval, 1.01 to 1.41; P=0.04); this association did not vary by race (interaction P=0.60). For white and black nondonors, there was a mean decline in eGFR (−0.4 and −0.3 ml/min per year, respectively) that steepened after incident hypertension (−0.8 and −0.9 ml/min per year, respectively; both P<0.001). For white and black kidney donors, there was a mean increase in eGFR after donation (+0.4 and +0.6 ml/min per year, respectively) that plateaued after incident hypertension (0 and −0.2 ml/min per year, respectively; P=0.07 and P=0.01, respectively, after hypertension).ConclusionsKidney donors are at higher risk of hypertension than similar healthy nondonors, regardless of race. Donors who developed hypertension had a plateau in the usual postdonation increase of eGFR.

scholarly journals A multicenter cohort study of potential living kidney donors provides predictors of living kidney donation and non-donation

2017 ◽  
Vol 92 (5) ◽  
pp. 1249-1260 ◽  
Author(s):  
Phillippa K. Bailey ◽  
Charles R.V. Tomson ◽  
Stephanie MacNeill ◽  
Ann Marsden ◽  
Dominique Cook ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Donation ◽  
Living Kidney Donation ◽  
Multicenter Cohort Study ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Multicenter Cohort

scholarly journals Perioperative Complications During Living Donor Nephrectomy: Results From a Multicenter Cohort Study

2019 ◽  
Vol 6 ◽  
pp. 205435811985771
Author(s):  
Carlos Garcia-Ochoa ◽  
Liane S. Feldman ◽  
Christopher Nguan ◽  
Mauricio Monroy-Cuadros ◽  
Jennifer Arnold ◽  
...  
Keyword(s):  
Online Survey ◽  
Perioperative Complications ◽  
Kidney Donation ◽  
Complication Rates ◽  
Living Kidney Donation ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Multicenter Cohort Study ◽  
Kidney Donors ◽  
Living Kidney Donors

Background: While living kidney donation is considered safe in healthy individuals, perioperative complications can occur due to several factors. Objective: We explored associations between the incidence of perioperative complications and donor characteristics, surgical technique, and surgeon’s experience in a large contemporary cohort of living kidney donors. Design: Living kidney donors enrolled prospectively in a multicenter cohort study with some data collected retrospectively after enrollment was complete (eg, surgeon characteristics). Setting: Living kidney donor centers in Canada (n = 12) and Australia (n = 5). Patients: Living kidney donors who donated between 2004 and 2014 and the surgeons who performed the living kidney donor nephrectomies. Measurements: Operative and hospital discharge medical notes were collected prospectively, with data on perioperative (intraoperative and postoperative) information abstracted from notes after enrollment was complete. Complications were graded using the Clavien-Dindo system and further classified into minor and major. In 2016, surgeons who performed the nephrectomies were invited to fill an online survey on their training and experience. Methods: Multivariable logistic regression models with generalized estimating equations were used to compare perioperative complication rates between different groups of donors. The effect of surgeon characteristics on the complication rate was explored using a similar approach. Poisson regression was used to test rates of overall perioperative complications between high- and low-volume centers. Results: Of the 1421 living kidney donor candidates, 1042 individuals proceeded with donation, where 134 (13% [95% confidence interval (CI): 11%-15%]) experienced 142 perioperative complications (55 intraoperative; 87 postoperative). The most common intraoperative complication was organ injury and the most common postoperative complication was ileus. No donors died in the perioperative period. Most complications were minor (90% of 142 complications [95% CI: 86%-96%]); however, 12 donors (1% of 1042 [95% CI: 1%-2%]) experienced a major complication. No statistically significant differences were observed between donor groups and the rate of complications. A total of 43 of 48 eligible surgeons (90%) completed the online survey. Perioperative complication rates did not vary significantly by surgeon characteristics or by high- versus low-volume centers. Limitations: Operative and discharge reporting is not standardized and varies among surgeons. It is possible that some complications were missed. The online survey for surgeons was completed retrospectively, was based on self-report, and has not been validated. We had adequate statistical power only to detect large effects for factors associated with a higher risk of perioperative complications. Conclusions: This study confirms the safety of living kidney donation as evidenced by the low rate of major perioperative complications. We did not identify any donor or surgeon characteristics associated with a higher risk of perioperative complications. Trial registration(s): NCT00319579: A Prospective Study of Living Kidney Donation ( https://clinicaltrials.gov/ct2/show/NCT00319579 ) NCT00936078: Living Kidney Donor Study ( https://clinicaltrials.gov/ct2/show/NCT00936078 )

Increasing Use of the Expanded Criteria for Living Kidney Donation and Good Outcomes of Living Kidney Donors in Korea

2016 ◽  
Vol 48 (7) ◽  
pp. 2407-2411 ◽  
Author(s):  
H.J. Lim ◽  
E. Jambaldorj ◽  
Y. Lee ◽  
S.S. Kang ◽  
T.Y. Koo ◽  
...  
Keyword(s):  
Kidney Donation ◽  
Living Kidney Donation ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Expanded Criteria

scholarly journals Risks of Living Kidney Donation

2019 ◽  
Vol 14 (4) ◽  
pp. 597-608 ◽  
Author(s):  
Krista L. Lentine ◽  
Ngan N. Lam ◽  
Dorry L. Segev
Keyword(s):  
Perioperative Complications ◽  
Kidney Donation ◽  
Preventative Care ◽  
Living Kidney Donation ◽  
Psychosocial Effects ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Increased Risk ◽  
Donation Process

In the past decade, there have been increasing efforts to better define and quantify the short- and long-term risks of living kidney donation. Recent studies have expanded upon the previous literature by focusing on outcomes that are important to potential and previous donors, applying unique databases and/or registries to follow large cohorts of donors for longer periods of time, and comparing outcomes with healthy nondonor controls to estimate attributable risks of donation. Leading outcomes important to living kidney donors include kidney health, surgical risks, and psychosocial effects of donation. Recent data support that living donors may experience a small increased risk of severe CKD and ESKD compared with healthy nondonors. For most donors, the 15-year risk of kidney failure is <1%, but for certain populations, such as young, black men, this risk may be higher. New risk prediction tools that combine the effects of demographic and health factors, and innovations in genetic risk markers are improving kidney risk stratification. Minor perioperative complications occur in 10%–20% of donor nephrectomy cases, but major complications occur in <3%, and the risk of perioperative death is <0.03%. Generally, living kidney donors have similar or improved psychosocial outcomes, such as quality of life, after donation compared with before donation and compared with nondonors. Although the donation process should be financially neutral, living kidney donors may experience out-of-pocket expenses and lost wages that may or may not be completely covered through regional or national reimbursement programs, and may face difficulties arranging subsequent life and health insurance. Living kidney donors should be fully informed of the perioperative and long-term risks before making their decision to donate. Follow-up care allows for preventative care measures to mitigate risk and ongoing surveillance and reporting of donor outcomes to inform prior and future living kidney donors.

scholarly journals Long-term risks after kidney donation: how do we inform potential donors? A survey from DESCARTES and EKITA transplantation working groups

2021 ◽  
Author(s):  
Geir Mjøen ◽  
Umberto Maggiore ◽  
Nicos Kessaris ◽  
Diederik Kimenai ◽  
Bruno Watschinger ◽  
...  
Keyword(s):  
Evaluation Process ◽  
Kidney Donation ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Relative Risks ◽  
Written Information ◽  
The Difference ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Publications from the last decade have increased knowledge regarding long-term risks after kidney donation. We wanted to perform a survey to assess how transplant professionals in Europe inform potential kidney donors regarding long-term risks. The objectives of the survey were to determine how they inform donors and to what extent, and to evaluate the degree of variation. Methods All transplant professionals involved in the evaluation process were considered eligible, regardless of the type of profession. The survey was dispatched as a link to a web-based survey. The subjects included questions on demographics, the information policy of the respondent and the use of risk calculators, including the difference of relative and absolute risks and how the respondents themselves understood these risks. Results The main finding was a large variation in how often different long-term risks were discussed with the potential donors, i.e. from always to never. Eighty percent of respondents stated that they always discuss the risk of end-stage renal disease, while 56% of respondents stated that they always discuss the risk of preeclampsia. Twenty percent of respondents answered correctly regarding the relationship between absolute and relative risks for rare outcomes. Conclusions The use of written information and checklists should be encouraged. This may improve standardization regarding the information provided to potential living kidney donors in Europe. There is a need for information and education among European transplant professionals regarding long-term risks after kidney donation and how to interpret and present these risks.

Sign in / Sign up

Export Citation Format

Share Document