scholarly journals Long-Term Kidney Outcomes in High BMI Living Kidney Donors: A Narrative Review

2017 ◽  
Vol 10 (1) ◽  
pp. 41-51
Author(s):  
Kalyani Murthy ◽  
Hannah Caldwell ◽  
Mary A. Simpson
Keyword(s):  
Risk Factor ◽  
Kidney Function ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Living Kidney Donors ◽  
Pubmed Search ◽  
Stage Renal Disease ◽  
End Stage

Background: The shortage of transplantable organs has led to the expansion of the living kidney donor (LKD) pool to include overweight (body mass index [BMI] 25-30 kg/m2) and obese (BMI ≥30 kg/m2) donors. Higher BMI is a known risk factor for chronic kidney disease and progression to end-stage renal disease. Methods & Materials: We focused our review on long-term kidney-related outcomes (kidney function, hypertension, and proteinuria) among higher BMI LKDs. A PubMed search retrieved a total of 27 articles reporting on renal outcomes for obese LKDs. Of these, nine studies with ≥5 years of follow-up were selected for inclusion. Results: Five studies reported a decrease in kidney function at follow-up for higher BMI LKDs. Higher BMI was noted as a risk factor for hypertension in six studies. Proteinuria was reported in six studies, and a significant association was noted with higher BMI status in three. Conclusion: This review highlights the continued need for long-term documentation of kidney function and related outcomes in higher BMI LKDs.

scholarly journals Hypertension, cardiovascular disease and cause of death in Danish living kidney donors: matched cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e041122
Author(s):  
Mavish Chaudry ◽  
Gunnar Hilmar Gislason ◽  
Emil Loldrup Fosbøl ◽  
Lars Køber ◽  
Thomas Alexander Gerds ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
General Population ◽  
Absolute Risk ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
The Absolute ◽  
Stage Renal Disease ◽  
End Stage

ObjectivesWe aimed to investigate the long-term absolute risk of hypertension and cardiovascular disease after kidney donation in living kidney donors.DesignLiving kidney donors were matched to 10 controls from the general population.SettingMultiple Danish national registries were used to identify living kidney donors from 1 January 1996 to 31 December 2017 nationwide.Participants1262 living kidney donors and 12 620 controls.Main outcome measuresHypertension, cardiovascular disease and diabetes.ResultsThe median age of living kidney donors was 52 (men 43%). Hypertension developed in 50 (4%) and 231 (1.8%) with a median follow-up of 7 years (IQR 3.3–12.1 years with a maximum follow-up of 22 years) and 6.9 years (IQR 3.2–11.7 years and maximum follow-up of 22 years) for donors and controls, respectively. The absolute risk of hypertension was 2.3% (95% CI 1.4% to 3.2%) and 1.2% (95% CI 1.0% to 1.4%), 4.2% (95% CI 2.8% to 5.7%) and 2.4% (95% CI 2.1% to 2.8%), 8.6% (95% CI 6.0% to 11.3%) and 3.3% (95% CI 2.8% to 3.8%) within 5, 10, 15 years for donors and controls, respectively. The ratio of the 10-year absolute risks for hypertension was 1.64 (95% CI 1.44 to 1.88) for donors compared with the controls. Two donors and four controls developed renal replacement therapy requiring end-stage renal disease during follow-up. The absolute risk of cardiovascular disease and diabetes was 7.3% (95% CI 5.7% to 9.5%) and 8.3% (95% CI 7.7% to 9.0%), 1.7% (95% CI 0.7% to 2.8%) and 3.2% (95% CI 2.7% to 3.6%) at 10 years for donors and controls, respectively.ConclusionsLiving kidney donors have an increased long-term absolute risk of hypertension compared with controls from the general population.

scholarly journals Living Kidney Donors Who Develop Kidney Failure: Excerpts of Their Thoughts

2016 ◽  
Vol 43 (6) ◽  
pp. 389-396 ◽  
Author(s):  
Colin M.E. Halverson ◽  
Jackie Y. Wang ◽  
Michael Poulson ◽  
Jennifer Karlin ◽  
Megan Crowley-Matoka ◽  
...  
Keyword(s):  
Decision Making ◽  
Living Donor ◽  
Qualitative Interviews ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Physical Support ◽  
Stage Renal Disease ◽  
End Stage

Background: Psychosocial data about living kidney donors have been collected for almost 5 decades now. To date, however, no study has provided any psychosocial follow-up of donors who developed a serious health problem such as end-stage renal disease (ESRD). Methods: Donors who developed ESRD were invited to participate in a qualitative interview if they met one or both of the inclusion criteria: (1) developed ESRD within 10 years of donating and/or (2) lacked health insurance at the time of donation. We contacted 38 individuals who met these criteria, and 22 participated (58%). Two were subsequently excluded from analysis. Results: Twenty qualitative interviews were analyzed. Five findings are described: (1) donors describe the decision-making process as spontaneous and fast; (2) donors describe lack of appreciation for the need for post-donation self-care; (3) donors do not regret donating despite the adverse outcome; (4) donors advise future donors to have in place emotional and physical support post donation; and (5) donors appreciate the opportunity to tell their story from being a living donor to living with ESRD, which virtually all perceive as 2 separate unrelated events. Conclusions: Most donors are positive about their donation decision and experience and would donate again, despite developing ESRD themselves. They propose some important changes to the decision-making and informed-consent processes. Our data are reassuring regarding lack of donor regret, but highlight the need for living donor transplant programs to ensure that living donors understand their long-term risks and receive appropriate life-long follow-up care to minimize these risks.

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.

scholarly journals End-stage renal disease: a risk factor of deep neck infection – a nationwide follow-up study in Taiwan

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Geng-He Chang ◽  
Ming-Shao Tsai ◽  
Chia-Yen Liu ◽  
Meng-Hung Lin ◽  
Yao-Te Tsai ◽  
...  
Keyword(s):  
Risk Factor ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Deep Neck Infection ◽  
Neck Infection ◽  
Follow Up Study ◽  
Stage Renal Disease ◽  
End Stage

Changing Risk Factor Demographics in End-Stage Renal Disease Patients Entering Hemodialysis and the Impact on Long-Term Mortality

1990 ◽  
Vol 15 (5) ◽  
pp. 422-432 ◽  
Author(s):  
Allan J. Collins ◽  
Ginger Hanson ◽  
Andrew Umen ◽  
Carl Kjellstrand ◽  
Prakash Keshaviah
Keyword(s):  
Risk Factor ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Long Term Mortality

P0485ASSOCIATION BETWEEN ANTI-GBM TITERS AND KIDNEY INFLAMMATION MEASURED BY A NEW ACTIVITY SCORE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Evelyn Hermida-Lama ◽  
Diana Rodríguez ◽  
David Cucchiari ◽  
Miquel Blasco ◽  
Gaston Piñeiro ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Kidney Function ◽  
Epidemiological Data ◽  
Median Number ◽  
History Of ◽  
Extra Point ◽  
Mixed Pattern ◽  
End Stage

Abstract Background and Aims Anti-glomerular basement membrane (anti-GBM) disease is an aggressive and rare glomerulopathy characterized by rapidly progressive loss of kidney function, leading to end stage kidney disease (ESKD) in a significant amount of cases. The main objective of our study was to determine whether anti-GBM titer correlated with the rate of activity in renal biopsy and long-term kidney survival in patients with anti-GBM, hence identifying patients who would potentially benefit from more intensive treatments. Method A retrospective analysis was performed on the cases of anti-GBM from our center that had both a positive biopsy and serology, from 2007 to 2019. Epidemiological data, anti-GBM levels on admission, kidney function at admission, discharge and follow-up, treatment and kidney biopsy findings were collected. All biopsies were reevaluated by a single, blinded pathologist and nephrologist. Based on a recent study by van Daalen et al, a chronicity and activity histopathological score was developed. The score was divided in glomerular and interstitial sections. In the glomerular section, a sclerotic pattern (>50% of glomeruli) was given 0 points in activity and 3 in chronicity, a mixed pattern was given 1 point in activity and chronicity, and a crescentic pattern (>50% with cellular crescents) was given 3 points in activity and 0 in chronicity. In the interstitial section, the presence of fibrosis and atrophy was given between 0 and 3 points in chronicity and the presence of tubulitis or interstitial infiltrate were given points in activity (0 to 1 and 0 to 3 respectively). The presence of neutrophils in the infiltrate was given one extra point in activity. Spearman correlation was performed between anti-GBM levels and our biopsy score. Results Twelve cases were identified, with a median Anti-GBM titer at admission of 292 U/mL (IQR 40-1517). Ten patients were treated with cyclophosphamide, 1 with rituximab plus cyclophosphamide and 1 with only rituximab. All patients received treatment with metilprednisona and plasma exchange with a median number of sessions of 8 (range: 6-12). Only one patient was not in ESKD during follow-up (35 months), so correlation with long-term kidney survival could not be performed. On the other hand, high antibody titers correlated with more activity on biopsy (correlation coefficient 0.592, p= 0.042) and less chronicity (correlation coefficient -0.657, p= 0.02). Conclusion These results suggest that patients who present with higher titers have more acute inflammation and less chronicity in renal parenchima, and therefore could benefit from more intensive treatment that changes the natural history of this aggressive disease. It would be interesting to study this score in larger and multicentric cohorts in order to produce more definitive conclusions.

scholarly journals Absence of renal remission portends poor long-term kidney outcome in lupus nephritis

2021 ◽  
Vol 8 (1) ◽  
pp. e000533
Author(s):  
Valérie Pirson ◽  
Antoine Enfrein ◽  
Frédéric A Houssiau ◽  
Farah Tamirou
Keyword(s):  
Lupus Nephritis ◽  
Negative Impact ◽  
Renal Outcome ◽  
Class Iii ◽  
Treatment Change ◽  
Lower Egfr ◽  
Stage Renal Disease ◽  
End Stage

BackgroundThe very long-term consequences of absence of remission in lupus nephritis (LN) remain understudied.MethodsIn this retrospective analysis, we studied a selected cohort of 128 patients with biopsy-proven class III, IV or V incident LN followed for a median period of 134 months (minimum 25). Remission was defined as a urine protein to creatinine (uP:C) ratio <0.5 g/g and a serum creatinine value <120% of baseline. Renal relapse was defined as the reappearance of a uP:C >1 g/g, leading to a repeat kidney biopsy and treatment change. Poor long-term renal outcome was defined as the presence of chronic kidney disease (CKD).ResultsTwenty per cent of patients never achieved renal remission. Their baseline characteristics did not differ from those who did. Absence of renal remission was associated with a threefold higher risk of CKD (48% vs 16%) and a 10-fold higher risk of end-stage renal disease (20% vs 2%). Patients achieving early remission had significantly higher estimated glomerular filtration rate (eGFR) at last follow-up compared with late remitters. Accordingly, patients with CKD at last follow-up had statistically longer time to remission. Among patients who achieved remission, 32% relapsed, with a negative impact on renal outcome, that is, lower eGFR values and higher proportion of CKD (33% vs 8%).ConclusionEarly remission should be achieved to better preserve long-term renal function.

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