Renal functional reserve capacity before and after living kidney donation

Am J Physiol Renal Physiol. 2018 Dec 1;315(6):F1550-F1554. doi: 10.1152/ajprenal.00064.2018. Epub 2018 Aug 8.

Abstract

Compensatory gomerular filtration rate (GFR) increase after kidney donation results in a GFR above 50% of the predonation value. The renal functional reserve (RFR) assessed by the renal response to dopamine infusion (RFRdopa) is considered to reflect functional reserve capacity and is thought to be a tool for living donor screening. However, it is unknown if the RFRdopa predicts long-term kidney function. Between 1984 and 2017, we prospectively measured GFR (125I-iothalamate) and RFR by dopamine infusion in 937 living kidney donors. We performed linear regression analysis of predonation RFRdopa and postdonation GFR. In donors with 5-yr follow-up after donation we assessed the association with long-term GFR. Mean donor age was 52 yr (SD 11); 52% were female. Mean predonation GFR was 114 ml/min (SD 22), GFRdopa was 124 ml/min (SD 24), resulting in an RFR of 9 ml/min (SD 10). Three months postdonation, GFR was 72 ml/min (SD 15) and GFRdopa was 75 ml/min (SD 15), indicating that donors still had RFRdopa [3 ml/min (SD 6), P < 0.001]. Predonation RFRdopa was not associated with predonation GFR [standardized (st.) β -0.009, P = 0.77] but was positively associated with GFR 3 mo after donation (st. β 0.12, P < 0.001). In the subgroup of donors with 5-yr follow-up data ( n = 383), RFRdopa was not associated with GFR at 5 yr postdonation (st. β 0.05, P = 0.35). In conclusion, RFRdopa is a predictor of short-term GFR after living kidney donation but not of long-term kidney function. Therefore, measurement of the RFRdopa is not a useful tool for donor screening. Studies investigating long-term renal adaptation are warranted to study the effects of living kidney donation and improve donor screening.

Keywords: dopamine; glomerular filtration rate; living kidney donation; renal functional reserve; renal hemodynamics; reserve capacity.

MeSH terms

  • Adult
  • Donor Selection / methods*
  • Dopamine / administration & dosage
  • Female
  • Glomerular Filtration Rate* / drug effects
  • Humans
  • Infusions, Intravenous
  • Kidney / drug effects
  • Kidney / physiopathology
  • Kidney / surgery*
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / methods*
  • Living Donors*
  • Male
  • Middle Aged
  • Nephrectomy* / adverse effects
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Dopamine