Association of Pre- and Post-Donation Renal Function with Midterm Estimated Glomerular Filtration Rate in Living Kidney Donors: A Retrospective Study

Abstract

Purpose: The estimated glomerular filtration rate (eGFR) at 6 months after donation (eGFR6m) is strongly associated with the risk of end-stage renal disease in living kidney donors. This study aimed to investigate the incidence of eGFR6m<60 mL/min/1.73 m2 (eGFR6m<60) and identify the risk factors that can predict the occurrence of eGFR6m <60 in living kidney donors.Materials and Methods: Living kidney donors who underwent nephrectomy at Severance Hospital between January 2009 and December 2019 were identified. We excluded 94 of 1233 donors whose creatinine values at 6 months after donation were missing. The risk factors for eGFR6m<60 were assessed using multivariate regression analysis. The optimal cutoff points for candidate risk factors for predicting eGFR6m <60 occurrence were determined using the Youden index.Results: The eGFR6m <60 occurred in 17.3% of the participants. Older age (>= 44 years), history of hypertension, lower preoperative eGFR (<101 mL/min/1.73 m2), and degree of increase in creatinine levels on postoperative day 2 compared to those before sur-gery (ACr2_pre) (>= 0.39 mg/dL) increased the risk of eGFR6m <60. The addition of ACr2_pre to preoperative eGFR yielded a higher predictive accuracy for predicting eGFR6m <60 than that with preoperative eGFR alone {area under the receiver operating charac-teristic curve=0.886 [95% confidence interval (CI), 0.863-0.908] vs. 0.862 (95% CI, 0.838-0.887), p<0.001}.Conclusion: The incidence of eGFR6m <60 was 17.3%. Older age, lower preoperative eGFR, history of hypertension, and greater ACr2_pre were associated with the occurrence of eGFR6m<60 after living donor nephrectomy. The combination of preoperative eGFR and ACr2_pre showed the highest predictive power for eGFR6m<60.