SHORT-TERM EFFECT OF RENAL DONATION IN AN INDIAN COHORT: A PROSPECTIVE OBSERVATIONAL STUDY

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Abstract Title

First Name *

Sandeep

Last Name *

Mahajan

Co-author 1

Priyanka Verma priyankavrma91@gmail.com All India Institute of Medical Sciences Nephrology New Dekhi

Co-author 2

Arun Kumar gmedaks@gmail.com All India Institute of Medical Sciences Nephrology New Delhi

Co-author 3

Rakesh Kumar rkphulia@yahoo.com All India Institute of Medical Sciences Nuclear Medicine New Delhi

Co-author 4

Dipankar Bhowmik dmbhowmik@aiims.edu All India Institute of Medical Sciences Nephrology New Delhi

Co-author 5

Soumita Bagchi soumita_bagchi@yahoo.co.in All India Institute of Medical Sciences Nephrology New Delhi

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Although renal donors are selected after detailed evaluation, donation results in decrease in nephron mass that can have important short & long-term renal implications. Though short-term effect of renal donation on estimated GFR (eGFR) has been reported, few studies from our sub-continent have systematically & prospectively followed-up renal donors in detail & done measured GFR (mGFR) in them

Methods

We in this single-center prospective study from India looked at changes in eGFR, mGFR, single kidney mGFR, proteinuria, renal size on ultrasonography & blood pressure in consecutive, consenting renal donors pre & at 1-year post-donation. 42 voluntary renal donors were enrolled. Note was made of baseline demographic, clinical profile & BP along with urine analysis, urine spot protein & creatinine ratio (UPCR), renal size on ultrasonography, eGFR (by CKD-Epi equation) & mGFR (by 2-point DTPA blood sampling method) & differential mGFR of non-donated kidney. Besides routine evaluation every 3 months all these parameters were repeated 1-year post-donation.

Results

Mean age of donors was 47.3±7.8 years with 65% being females. Mean eGFR and mGFR at baseline were 106.2±13.3 ml/min/1.73m2 & 86.5±11.2 ml/min/1.73m2 respectively. At 1 year, eGFR & mGFR were 79.8±16.3 ml/min/1.73m2 & 53.1±10.1 ml/min/1.73m2 respectively (p<0.001, from baseline). Size of non-donated kidney increased from 9.5±0.6 cm to 10.1±0.6 cm (p<0.001) with a corresponding increase in single kidney mGFR of 22.3 % (from 43.43 to 53.10 ml/min/1.73m2). However, at 1 year 76.2%% renal donors had mGFR of <60 ml/min/1.73m2. UPCR increased from 82.5±38.7 mg/gm to 200.7±117.3 mg/gm (p=0.001). Mean systolic & diastolic BP increased by 5 mmHg (p=0.015) & 3 mmHg (p=0.48) respectively, while 14.3% donors were diagnosed with new onset hypertension during follow-up

Conclusions

In this prospective study we found physiological renal compensation in terms of gain in single kidney GFR and increase in kidney size. It however came at cost of increased proteinuria and higher SBP. Inspite of expected compensation, nearly 2/3rd of our donors had a mGFR of <60. This could be due to lower baseline GFR in our population because of lower protein intake and other ethnic reasons. Since, this is first Indian study assessing the measured GFR by isotopic plasma method in this population these results need to be confirmed by longer multicentric studies involving larger sample size

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