Summary of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

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Abstract

Kidney Disease: Improving Global Outcomes (KDIGO) engaged an evidence review team and convened a work group to produce a guideline to evaluate and manage candidates for living kidney donation. The evidence for most guideline recommendations is sparse and many “ungraded” expert consensus recommendations were made to guide the donor candidate evaluation and care before, during, and after donation. The guideline advocates for replacing decisions based on assessments of single risk factors in isolation with a comprehensive approach to risk assessment using the best available evidence. The approach to simultaneous consideration of each candidate’s profile of demographic and health characteristics advances a new framework for assessing donor candidate risk and for defensible shared decision making.

Abstract

One of the most important tasks we have to undertake is to evaluate and then care for living donors. This paper provides a summary of the KDIGO Guidelines and encapsulates what you will find in the guidelines themselves, which are published in full in a separate supplement. Care of our living kidney donors is not an evidence free void for personal opinion and practice to fill–there are data.

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Gestational hypertension and preeclampsia in living kidney donors.

Amit X Garg, Immaculate F Nevis, Eric McArthur … (2015)

Young women wishing to become living kidney donors frequently ask whether nephrectomy will affect their future pregnancies.

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Racial variation in medical outcomes among living kidney donors.

Huiling Xiao, Daniel Brennan, Tessa Davis … (2010)

Data regarding health outcomes among living kidney donors are lacking, especially among nonwhite persons. We linked identifiers from the Organ Procurement and Transplantation Network (OPTN) with administrative data of a private U.S. health insurer and performed a retrospective study of 4650 persons who had been living kidney donors from October 1987 through July 2007 and who had post-donation nephrectomy benefits with this insurer at some point from 2000 through 2007. We ascertained post-nephrectomy medical diagnoses and conditions requiring medical treatment from billing claims. Cox regression analyses with left and right censoring to account for observed periods of insurance benefits were used to estimate absolute prevalence and prevalence ratios for diagnoses after nephrectomy. We then compared prevalence patterns with those in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) for the general population. Among the donors, 76.3% were white, 13.1% black, 8.2% Hispanic, and 2.4% another race or ethnic group. The median time from donation to the end of insurance benefits was 7.7 years. After kidney donation, black donors, as compared with white donors, had an increased risk of hypertension (adjusted hazard ratio, 1.52; 95% confidence interval [CI], 1.23 to 1.88), diabetes mellitus requiring drug therapy (adjusted hazard ratio, 2.31; 95% CI, 1.33 to 3.98), and chronic kidney disease (adjusted hazard ratio, 2.32; 95% CI, 1.48 to 3.62); findings were similar for Hispanic donors. The absolute prevalence of diabetes among all donors did not exceed that in the general population, but the prevalence of hypertension exceeded NHANES estimates in some subgroups. End-stage renal disease was identified in less than 1% of donors but was more common among black donors than among white donors. As in the general U.S. population, racial disparities in medical conditions occur among living kidney donors. Increased attention to health outcomes among demographically diverse kidney donors is needed. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.)

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Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease.

Ronit Calderon-Margalit, Alon Farfel, Asaf Vivante … (2011)

Few data are available on long-term outcomes among adolescents and young adults with persistent asymptomatic isolated microscopic hematuria. To evaluate the risk of end-stage renal disease (ESRD) in adolescents and young adults with persistent asymptomatic isolated microscopic hematuria. Nationwide, population-based, retrospective cohort study using medical data from 1,203,626 persons aged 16 through 25 years (60% male) examined for fitness for military service between 1975 and 1997 were linked to the Israeli treated ESRD registry. Incident cases of treated ESRD from January 1, 1980, to May 31, 2010, were included. Cox proportional hazards models were used to estimate the hazard ratio (HR) of treated ESRD among those diagnosed as having persistent asymptomatic isolated microscopic hematuria. Treated ESRD onset, defined as the date of initiation of dialysis treatment or the date of renal transplantation, whichever came first. Persistent asymptomatic isolated microscopic hematuria was diagnosed in 3690 of 1,203,626 eligible individuals (0.3%). During 21.88 (SD, 6.74) years of follow-up, treated ESRD developed in 26 individuals (0.70%) with and 539 (0.045%) without persistent asymptomatic isolated microscopic hematuria, yielding incidence rates of 34.0 and 2.05 per 100,000 person-years, respectively, and a crude HR of 19.5 (95% confidence interval [CI], 13.1-28.9). A multivariate model adjusted for age, sex, paternal country of origin, year of enrollment, body mass index, and blood pressure at baseline did not substantially alter the risk associated with persistent asymptomatic isolated microscopic hematuria (HR, 18.5 [95% CI, 12.4-27.6]). A substantially increased risk for treated ESRD attributed to primary glomerular disease was found for individuals with persistent asymptomatic isolated microscopic hematuria compared with those without the condition (incidence rates, 19.6 vs 0.55 per 100,000 person-years, respectively; HR, 32.4 [95% CI, 18.9-55.7]). The fraction of treated ESRD attributed to microscopic hematuria was 4.3% (95% CI, 2.9%-6.4%). Presence of persistent asymptomatic isolated microscopic hematuria in persons aged 16 through 25 years was associated with significantly increased risk of treated ESRD for a period of 22 years, although the incidence and absolute risk remain quite low.

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Author and article information

Journal

Journal ID (nlm-ta): Transplantation

Journal ID (iso-abbrev): Transplantation

Journal ID (publisher-id): TP

Title: Transplantation

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 0041-1337

ISSN (Electronic): 1534-6080

Publication date (Print): August 2017

Publication date (Electronic): 31 July 2017

Volume: 101

Issue: 8

Pages: 1783-1792

Affiliations

[1] ¹ Saint Louis University School of Medicine, St. Louis, MO.

[2] ² Hennepin County Medical Center, Minneapolis, MN.

[3] ³ Tufts Medical Center, Boston, MA.

[4] ⁴ Wake Forest School of Medicine, Winston-Salem, NC.

[5] ⁵ Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

[6] ⁶ Mansoura University, Mansoura, Egypt.

[7] ⁷ Northwestern University, Chicago, IL.

[8] ⁸ University of Minnesota, Minneapolis, MN.

[9] ⁹ Indraprastha Apollo Hospitals, New Delhi, India.

[10] ¹⁰ Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.

[11] ¹¹ Johns Hopkins University School of Medicine, Baltimore, MD.

[12] ¹² Mayo Clinic, Rochester, MN.

[13] ¹³ Tokyo Women's Medical University, Tokyo, Japan.

[14] ¹⁴ University of Toronto, Toronto, Canada.

[15] ¹⁵ University Hospital Heidelberg, Heidelberg, Germany.

[16] ¹⁶ KDIGO, Brussels, Belgium.

[17] ¹⁷ Western University, London, Ontario, Canada.

Author notes

Correspondence: Krista L. Lentine, MD, PhD, Center for Abdominal Transplantation, Saint Louis University Medical Center 9-FDT, 1402 S. Grand Blvd., St. Louis, MO 63104. ( lentinek@ 123456slu.edu ).

Article

Publisher ID: TP501037 Accession ID: 00014

DOI: 10.1097/TP.0000000000001770

PMC ID: 5542788

PubMed ID: 28737659

SO-VID: 47c712b9-3278-4b38-a0e8-eb7b7fb99bda

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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Date received : 29 March 2017

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Summary of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

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Most cited references 40

Gestational hypertension and preeclampsia in living kidney donors.

Racial variation in medical outcomes among living kidney donors.

Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease.

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