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Comparison of change in estimated and measured Glomerular Filtration Rate in living kidney donors Anthony Wijninga

(2017) Wijninga, A. (Anthony)

Introduction: Living kidney transplantation is the best treatment for patients with End Stage
Renal Disease (ESRD). Due to the rising demand of donor kidneys, many transplant centers have
liberalized their selection criteria for kidney donating, possibly increasing donor risks of ESRD.
Early detection of declining kidney function is critical for these donors. Whether estimated
Glomerular Filtration Rate (eGFR) accurately depicts changes in GFR in donors is unknown.
Aim: To compare the mGFR slope with eGFR slopes in a longitudinal cohort study in living
kidney donors and evaluate which equation can be used to assess long-term kidney function in
this population.
Materials and methods: In 349 donors, we compared eGFR (MDRD-, CKD-Epi, Cockcroft-Gault
(CG/BSA) and CKD-EPI-Cystatin C) and mGFR (125I-iothalamate) slopes assessing changes in
renal function from 3 months until 5 years after donation. We calculated the bias of eGFR slopes
to test accuracy and IQR and RMSE to test precision.
Results: Mean age at donation was 51±10 years, 46% were male and mean mGFR was 116±23
mL/min. mGFR at short-term follow-up was 73±14, 79±16 at long-term follow-up and 78±16 at
extended follow-up. Of all eGFR equations, CG/BSA has the lowest bias (-0.08±2.06), followed
by CKD-EPI (0.13±2.16), MDRD (0.19±2.10) and CKD-EPI-CysC (-0.45±2.70). All eGFR
equations underestimated the mGFR slope in donors with a declining mGFR.
Conclusion: eGFR equations are unable to reliably determine kidney function decline in living
kidney donors with declining mGFR. These results highlight the need of mGFR in the follow-up
of living kidney donors.

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