Estimated glomerular filtration rate (eGFR) in living kidney donors (LKDs) at 6 months after donation is an early marker of end-stage renal disease (ESRD) risk, according to investigators.

In a study of all 71,468 LKDs in the United States during 1999 to 2018, the cumulative incidence of ESRD at 15 years after donation ranged from 11.7 per 10,000 donors with a 6-month eGFR value exceeding 70 mL/min/1.73 m2 to 33.1 per 10,000 donors with a 6-month eGFR of 50 mL/min/1.73 m2 or less. Every 10 mL/min/1.73 m2 decrement in 6-month eGFR correlated with a significant 28% increase in ESRD risk, Dorry L. Segev, MD, PhD, of Johns Hopkins Medical Institutions in Baltimore, and colleagues reported in JAMA Surgery. In contrast, neither predonation eGFR nor eGFR decline proved as predictive. The investigators adjusted for age, race, sex, body mass index, and biological relationship.

“The findings support measurement of early postdonation serum creatinine monitoring in living kidney donors, and the use of these data to help identify donors who might need more careful surveillance and early intervention,” Dr Segev’s team stated.

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In an accompanying editorial, Arthur J. Matas, MD, of the University of Minnesota in Minneapolis, and coauthors highlighted some outstanding questions. ESRD developed in only 75 patients (0.1%), and these patients were more likely to be black (22.7% vs 10.9%) and related to the kidney recipient (68.0% vs 47.2%). The individual characteristics of these 75 patients (eg, APOL1 high-risk alleles), causes of ESRD, and the interval from donation to ESRD diagnosis are important considerations, the editorialists pointed out.

“Although the incidence of postdonation ESRD is low, the transplant community should make every effort to understand its pathogenesis and determine if selection criteria or postdonation care can be improved to minimize long-term risk,” Dr Mattas and his coauthors wrote. “Becoming a kidney donor should include a lifetime commitment to a healthy lifestyle and regular medical evaluations.”

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Massie AB, Holscher CM, Henderson ML, et al. Association of early postdonation renal function with subsequent risk of end-stage renal disease in living kidney donors [published online January 22, 2020]. JAMA Surg. doi: 10.1001/jamasurg.2019.5472

Matas AJ, Ibrahim HN, Vock DM. End-stage renal disease after kidney donation—More research needed [published online January 22, 2020]. JAMA Surg. doi: 10.1001/jamasurg.2019.5473