Cardiovascular Effects of Unilateral Nephrectomy in Living Kidney Donors at 5 Years.
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ABSTRACT:
SUBMITTER: Price AM
PROVIDER: S-EPMC7968960 | biostudies-literature | 2021 Apr
REPOSITORIES: biostudies-literature
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Cardiovascular Effects of Unilateral Nephrectomy in Living Kidney Donors at 5 Years.
Price Anna M AM Moody William E WE Stoll Victoria M VM Vijapurapu Ravi R Hayer Manvir K MK Biasiolli Luca L Weston Chris J CJ Webster Rachel R Wesolowski Roman R McGee Kirsty C KC Liu Boyang B Baig Shanat S Pickup Luke C LC Radhakrishnan Ashwin A Law Jonathan P JP Edwards Nicola C NC Steeds Richard P RP Ferro Charles J CJ Townend Jonathan N JN
Hypertension (Dallas, Tex. : 1979) 20210208 4
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Project description:ImportanceLiving kidney donors may have an increased risk of fractures due to reductions in kidney mass, lower concentrations of serum 1,25-dihydroxyvitamin D, and secondary increases in serum parathyroid hormone.ObjectiveTo compare the overall and site-specific risk of fractures among living kidney donors with strictly matched controls from the general population who would have been eligible to donate a kidney but did not do so.Design, setting, and participantsThis survey study was conducted between December 1, 2021, and July 31, 2023. A total of 5065 living kidney donors from 3 large transplant centers in Minnesota were invited to complete a survey about their bone health and history of fractures, and 16 156 population-based nondonor controls without a history of comorbidities that would have precluded kidney donation were identified from the Rochester Epidemiology Project and completed the same survey. A total of 2132 living kidney donors and 2014 nondonor controls responded to the survey. Statistical analyses were performed from May to August 2023.ExposureLiving kidney donation.Main outcomes and measuresThe rates of overall and site-specific fractures were compared between living kidney donors and controls using standardized incidence ratios (SIRs).ResultsAt the time of survey, the 2132 living kidney donors had a mean (SD) age of 67.1 (8.9) years and included 1245 women (58.4%), and the 2014 controls had a mean (SD) age of 68.6 (7.9) years and included 1140 women (56.6%). The mean (SD) time between donation or index date and survey date was 24.2 (10.4) years for donors and 27.6 (10.7) years for controls. The overall rate of fractures among living kidney donors was significantly lower than among controls (SIR, 0.89; 95% CI, 0.81-0.97). However, there were significantly more vertebral fractures among living kidney donors than among controls (SIR, 1.42; 95% CI, 1.05-1.83).Conclusions and relevanceThis survey study found a reduced rate of overall fractures but an excess of vertebral fractures among living kidney donors compared with controls after a mean follow-up of 25 years. Treatment of excess vertebral fractures with dietary supplements such as vitamin D3 may reduce the numbers of vertebral fractures and patient morbidity.
| S-EPMC10809017 | biostudies-literature
Project description:We investigated the dynamic change of mineral bone metabolism and explored factors associated with the alteration of mineral bone metabolism in the living kidney donors (LKDs) after uni-nephrectomy. One-hundred forty-four prospective LKDs who underwent kidney donation between May 2016 and September 2018 were enrolled. Laboratory evaluation regarding mineral bone metabolism including intact parathyroid hormone (iPTH), renal fractional excretion of phosphate (FEPi), and technetium-99m diethylenetriaminepentaacetate (99mTc-DTPA) scan was performed predonation and 6 months after donation. We divided donors into two groups, the low ΔFEPi and high ΔFEPi groups, according to the change of FEPi after donation, and investigated significant risk factors associated with high ΔFEPi. At 6 months after uni-nephrectomy, estimated glomerular filtration rate (eGFR) significantly declined by 30.95 ml/min/1.73 m2 (p < 0.001), but the measured GFR (mGFR) of the remaining kidney by 99mTc-DTPA scan showed significant increase. Serum phosphorus decreased (p < 0.001), whereas FEPi (13.34-20.23%, p < 0.001) and serum iPTH (38.70-52.20 pg/ml, p < 0.001) showed significant increase. In the high ΔFEPi group, the proportion of preexisting hypertension (HTN) was higher, the baseline FEPi was lower, and the percent decline in eGFR was greater. Moreover, all of these factors were independently associated with high ΔFEPi upon multivariable logistic regression analysis. LKDs showed a significant change in mineral bone metabolism after uni-nephrectomy, especially when the donors had preexisting HTN, lower baseline FEPi, and showed greater loss of kidney function. Hence, strict monitoring of the mineral bone metabolism parameters and bone health may be required for these donors.
| S-EPMC8554047 | biostudies-literature
Project description:Introduction Hypertension has been considered a contraindication for living kidney donation in the past. Since transplantation from living kidney donors remains the best modality for kidney failure, there is now an increased acceptance of living kidney donors with hypertension. However, the safety of this practice for the cardiovascular and kidney health of the donor is unclear. We will conduct a systematic review to summarise and synthesise the existing literature on this topic. Methods and analysis A systematic review of prospective randomised and non-randomised and retrospective studies will be conducted. MEDLINE, EMBASE, Cochrane CENTRAL and EBM reviews published from January 1946 to December 2021 will be reviewed. Primary outcome will be the difference in the survival, major adverse cardiovascular events, estimated glomerular filtration rate of 45 mL/min or less and development of end-stage kidney failure, between living kidney donors with and without hypertension. Study screening, selection, and data extraction will be performed by two independent reviewers. Studies must fulfil all eligibility criteria for inclusion into the systematic review and meta-analysis. The Risk of Bias in Non-Randomised studies tool will be used to assess bias. Ethics and dissemination No ethical approval is required for this systematic review. The results of this review will be disseminated in a peer-reviewed, open-access journal to ensure access to all stakeholders in kidney transplantation and to inform clinical guidelines on the evaluation and follow-up care of living kidney donor candidates. PROSPERO registration number CRD42022300119.
| S-EPMC9756152 | biostudies-literature
Project description:The aim of this study was to explore biological interaction and pathophysiology mechanisms in a new mouse model of cardiovascular-kidney-metabolic (CKM) syndrome, induced by chronic moderate renal failure in combination with consumption of a customized Western diet rich in carbohydrates, fat and salt. Male C57BL/6J mice were subjected to unilateral nephrectomy, fed a customized Western diet rich not only in sugar and fat but also in salt, and followed for 12 weeks or 20 weeks. Sham-operated mice on a standard chow served as healthy controls. Body composition, weight gain, glucose metabolism, fat distribution, blood pressure, cardiac function, vascular reactivity, renal function, inflammation and mitochondrial function were measured and combined with biochemical and histopathological analyses. The novel triple-hit model of CKM syndrome showed signs and symptoms of metabolic syndrome, disturbed glucose metabolism, impaired adipocyte physiology and fat redistribution, cardiovascular dysfunction, renal damage and dysfunction, systemic inflammation, elevated blood pressure and cardiac remodeling. The pathological changes were more pronounced in mice after prolonged exposure for 20 weeks, but no deaths occurred. In the present mouse model of CKM syndrome, profound and significant metabolic, cardiac, vascular and renal dysfunctions and injuries emerged by using a Western diet rich not only in fat and carbohydrates but also in salt. This multisystem disease model could be used for mechanistic studies and the evaluation of new therapeutic strategies.
| S-EPMC11519006 | biostudies-literature
Project description:Unilateral Nephrectomy is one of the most common treatments for surgical diseases of the kidney but often results in postsurgical acute kidney injury (AKI). In the current study, we aimed to investigate the risk factors for AKI in patients who have received Unilateral Nephrectomy. We retrospectively analysed 528 patients who underwent Unilateral Nephrectomy for different etiologies between January 2013 and December 2018 at the Affiliated Hospital of Qingdao University. We recorded the prevalence and severity of AKI, age, gender, diabetes, body mass index (BMI), hypertension, preoperative renal function, etiology, performed surgically, anaemia, albumin, coagulation, lactate dehydrogenase, nitrogen (BUN), and uric acid. Univariate and multivariate logistic regression analyses were used to investigate the predictors of AKI in patients with Unilateral Nephrectomy. Overall, 218 of the 528 patients (41.2%) developed AKI during their hospitalisation. Univariate analysis showed that AKI was significantly associated with gender (male, OR = 1.866, P = 0.001), overweight (OR = 2.19, P = 0.0002), and surgical approach (OR = 1.7, P = 0.018), while multivariate logistic regression analysis showed that male gender (OR = 1.953, P = 0.001), overweight (OR = 2.176, P = 0.001), and preoperative renal function (OR = 0.507, P = 0.001) were independent factors for AKI. Regression analysis among different etiologies showed significant differences in postoperative AKI. After Unilateral nephrectomy, AKI is more likely to occur in overweight male patients with normal kidney function. AKI occurred more frequently in patients who are kidney donors, but rarely in those with non-function kidneys.
| S-EPMC11489668 | biostudies-literature
Project description:Living kidney donors are screened for transmissible diseases including cancer. Outcomes following donation are excellent, but concern exists regarding development of chronic kidney disease, and cancer risk is unknown. We used linked transplant and cancer registry data to identify incident cancers among 84,357 kidney donors in the United States (1995-2017). We compared risk with the general population using standardized incidence ratios (SIRs). For selected cancers, we used Poisson regression to compare donors with 47,451 Adventist Health Study 2 (AHS-2) participants, who typically have healthy lifestyles. During follow-up, 2843 cancers were diagnosed in donors, representing an overall deficit (SIR 0.79, 95%CI 0.76-0.82). None of 46 specified cancer sites occurred in excess relative to the general population, and 15 showed significant deficits (SIR < 1.00). Compared with AHS-2 participants, donors had similar incidence of liver cancer, melanoma, breast cancer, and non-Hodgkin lymphoma but, starting 7 years after donation, elevated incidence of colorectal cancer (adjusted incidence rate ratio 2.07, 95%CI 1.54-2.79) and kidney cancer (2.97, 1.58-5.58, accounting for the presence of a single kidney in donors). Elevated kidney cancer incidence may reflect adverse processes in donors' remaining kidney. Nonetheless, cancer risk is lower than in the general population, suggesting that enhanced screening is unnecessary.
| S-EPMC9357116 | biostudies-literature
Project description:BACKGROUND AND OBJECTIVES:The fraction of kidneys procured for transplant that are discarded is rising in the United States. Identifying donors from whom only one kidney was discarded allows us to control for donor traits and better assess reasons for organ discard. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:We conducted a retrospective cohort study using United Network for Organ Sharing Standard Transplant Analysis and Research file data to identify deceased donors from whom two kidneys were procured and at least one was transplanted. Unilateral pairs were defined as kidney pairs from a single donor from whom one kidney was discarded ("unilateral discard") but the other was transplanted ("unilateral transplant"). Organ quality was estimated using the Kidney Donor Risk Index and Kidney Donor Profile Index (KDPI). We compared all-cause graft failure rates for unilateral transplants to those for bilateral transplant Kaplan-Meier methods, and life table methodology was used to evaluate 1-, 2-, 3-, and 5-year survival rates of transplants from bilateral and unilateral donors. RESULTS:Compared with bilateral donors (i.e., both kidneys transplanted) (n=80,584), unilateral donors (i.e., only one kidney transplanted) (n=7625) had higher mean terminal creatinine (1.3±2.1 mg/dl versus 1.1±0.9 mg/dl) and KDPI (67%±25% versus 42%±27%), were older, and were more likely to have hypertension, diabetes, hepatitis C, terminal stroke, or meet Centers for Disease Control and Prevention high-risk donor criteria. Unilateral discards were primarily attributed to factors expected to be similar in both kidneys from a donor: biopsy findings (22%), no interested recipient (13%), and donor history (7%). Anatomic abnormalities (14%), organ damage (11%), and extended ischemia (6%) accounted for about 30% of discards, but were the commonest reasons among low KDPI kidneys. Among kidneys with KDPI≥60%, there was an incremental difference in allograft survival over time (for unilateral versus bilateral transplants, 1-year survival: 83% versus 87%; 3-year survival: 69% versus 73%; 5-year survival: 51% versus 58%). CONCLUSIONS:A large number of discarded kidneys were procured from donors whose contralateral kidneys were transplanted with good post-transplant outcomes.
| S-EPMC5753314 | biostudies-literature
Project description: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.
| S-EPMC7654106 | biostudies-literature
Project description:Purpose: Experiments were done in mice undergoing unilateral nephrectomy (UNx) and sham nephrectomy. At specific time points (24 hours and 72 hours) after surgery, the earliest first portion of the kidney proximal tubule (PT-S1) and the cortical collecting duct (CCD) were manually micro-dissected and utilized for transcriptomic analysis by single-tubule small sample RNA-Seq. Methods: We carried out RNA-sequencing in microdissected ealiest portion of proximal tubules (PT-S1) or cortical collecting duct (CCD) from mice with or without (sham) unilateral nephrectomy (UNx). Each group (Sham or UNx) has 3-5 biological replicates. Results and conclusion: RNA-Seq in microdissected PT-S1 at 24 hours showed that peroxisome proliferator-activated receptor alpha (PPARα) target genes were strongly upregulated. RNA-Seq in microdissected PT-S1 at 72 hours showed that cell cycle related genes were strongly upregulated. RNA-Seq in microdissected CCD at both 24 hours and 72 hours showed that cell cycle related genes were strongly upregulated.
2022-08-14 | GSE211021 | GEO
Project description:An increased risk of ESRD has been reported for living kidney donors, and appears to be higher for those donating to a relative. The reasons for this are not clear. One possibility is that ESRD is due to the nephrectomy-related reduction in GFR, followed by an age-related decline that may be more rapid in related donors. Between 1/1/1990 and 12/31/2014, we did 2002 living donor nephrectomies. We compared long-term postdonation eGFR trajectory for donors with (n = 1245) vs. without (n = 757) a first-degree relative with ESRD. Linear mixed-effects models were used to model the longitudinal trajectory of eGFR. With all other variables held constant, we noted a steady average increase in eGFR until donors reached age 70: 1.12 (95% CI: 0.92-1.32) mL/min/1.73m² /yr between 6 weeks and 5 years postdonation; 0.24 (0.00-0.49) mL/min/1.73m² /yr between 5 and 10 years; and 0.07 (-0.10 to +0.25) mL/min/1.73m² /yr between 10 and 20 years for donors with attained age less than 70. After age 70, eGFR declined. After we adjusted for predonation factors, the difference in eGFR slopes between related and unrelated donors was 0.20 mL/min/1.753 m2 /year (0.07-0.33). Our data suggests that postdonation, kidney donor eGFR increases each year for a number of years and that eGFR trajectory does not explain any increase in ESRD after donation.
| S-EPMC5820146 | biostudies-literature