Advertisement

Cardiovascular Disease Risk in Living Kidney Donors: Knowns and Unknowns

  • Elif AriEmail author
  • Tugce Uzar
  • Sena Eksi
Cardiovascular Disease (R Forkaer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardiovascular Disease
  2. Topical Collection on Cardiovascular Disease

Abstract

Purpose of Review

This review aimed to summarize evidence regarding mid- and long-term cardiovascular risks associated with living kidney donation in adults.

Recent Findings

Chronic kidney disease is a major risk factor for cardiovascular disease. It is known that glomerular filtration rate declines among many donors after donation; as a result, these donors can be classified as having early stage chronic kidney disease. Even though initial reports suggested no increase in adverse cardiovascular effects compared with control populations, recent data have shown a possible late increase in cardiovascular event rates and small structural and functional cardiovascular abnormalities. The long-term significance of these abnormalities is unknown.

Summary

It is not possible to draw strong conclusions on whether the reduction in glomerular filtration rate caused by kidney donation causes an increase in adverse cardiovascular events. Further prospective studies are needed to evaluate the natural history of cardiac and vascular structural and functional abnormalities and their clinical significance.

Keywords

Kidney donation Cardiovascular Chronic kidney disease 

Notes

Compliance With Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    O’Keeffe LM, Ramond A, Oliver-Williams C, Willeit P, Paige E, Trotter P, et al. Mid-and long-term health risks in living kidney donors: a systematic review and meta-analysis. Ann Intern Med. 2018 Feb;168(4):276–84.CrossRefPubMedGoogle Scholar
  2. 2.
    Reese PP, Boudville N, Garg AX. Living kidney donation: outcomes, ethics, and uncertainty. Lancet. 2015 May;385(9981):2003–13.CrossRefPubMedGoogle Scholar
  3. 3.
    Chronic Kidney Disease Prognosis Consortium1, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010 Jun:375(9731):2073–81.Google Scholar
  4. 4.
    ••Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, et al. Long-term consequences of kidney donation. N Engl J Med 2009 Jan:360(5):459–69. Large retrospective study among 3698 kidney donors who donated kidneys during the period from 1963 through 2007. Results indicate that survival and the risk of chronic kidney disease in carefully screened kidney donors appear to be similar to those in the general population. Most donors who were studied had a preserved glomerular filtration rate, normal albumin excretion, and an excellent quality of life. Google Scholar
  5. 5.
    Liborio AB, Barros RM, Esmeraldo RM, Oliveria MLMB, Silva GB, Daher EF. Creatinine-based equations predicting chronic kidney disease after kidney donation. Transplant Proc. 2011;43(7):2481–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Karahan M, Yildirim M, Kucuk HF, Turunc V, Demir H, Salturk C, et al. Oxidative DNA damage is increased in living kidney donors. Trans Proc. 2019 May;51(4):1049–53.CrossRefGoogle Scholar
  7. 7.
    Mjoen G, Reisaeter A, Hallan S, Line PD, Hartmann A, Midtvedt K, et al. Overall and cardiovascular mortality in Norwegian kidney donors compared to the background population. Nephrol Dial Transplant. 2012 Jan;27(1):443–7.CrossRefPubMedGoogle Scholar
  8. 8.
    ••Mjoen G, Hallan S, Hartmann A, Foss A, Midtvedt K, Oyen O, et al. Long-term risks for kidney donors. Kidney Int 2014 Jul:86(1):162–7 .First study shows a late rise in adverse cardiovascular events among kidney donors. Results indicate that kidney donors are at increased long-term risk for end-stage kidney disease, cardiovascular, and all-cause mortality compared with a healthy control group. Google Scholar
  9. 9.
    Garg AX, Meirambayeva A, Huang A, Kim J, Prasad GVR, Knoll G, et al. Cardiovascular disease in kidney donors: matched cohort study. BMJ. 2012 Mar 1;344:e1203.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Boudville N, Prasad GV, Knoll G, Muirhead N, Thiessen-Philbrook H, Yang RC, et al. Meta analysis: risk for hypertension in living kidney donors. Ann Intern Med. 2006 Aug;145(3):185–96.CrossRefPubMedGoogle Scholar
  11. 11.
    ••Thiel GT, Nolte C, Tsinalis D, Steiger J, Bachmann LM. Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors. BMJ Open 2016 Mar:6(3):e010869. Large prospective cohort study among 1214 living kidney donors in Switzerland. Results show that kidney donation increases the risk for developing hypertension and sensitizes the remaining kidney to hypertensive glomerular damage as expressed by increased albumin excretion in living kidney donors. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Garg AX, Muirhead N, Knoll G, Yang RC, Prasad GV, Thiessen-Philbrook H, et al. Proteinuria and reduced kidney function in living kidney donors: a systematic review, meta-analysis, and meta-regression. Kidney Int. 2006 Nov;70(10):1801–10.CrossRefPubMedGoogle Scholar
  13. 13.
    ••Kasiske BL, Anderson-Haag T, Israni AK, Kalil RS, Kimmel PL, Kraus ES, et al. A prospective controlled study of living kidney donors: three-year follow-up. Am J Kidney Dis 2015 Jul:66(1):114–24. A large, prospective, controlled, observational cohort study among living kidney donors. Results indicate that blood pressure and 24-hour ambulatory blood pressure parameters were similar in controls and kidney donors. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Moody WE, Ferro CJ, Edward NC, Chue CD, Lin EL, Taylor RJ, et al. Cardiovascular effects of unilateral nephrectomy in living kidney donors. Hypertension. 2016 Feb;67(2):368–77.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Altmann U, Böger CA, Farkas S, Mack M, Luchner A, Hamer OW, et al. Effects of reduced kidney function because of living kidney donation on left ventricular mass. Hypertension. 2017 Feb;69(2):297–303.CrossRefPubMedGoogle Scholar
  16. 16.
    Hewing B, Dreger H, Knebel F, Spethmann S, Poller WC, Dehn AM, et al. Midterm echocardiographic follow-up of cardiac function after living kidney donation. Clin Nephrol. 2015 May;83(5):253–61.CrossRefPubMedGoogle Scholar
  17. 17.
    Moody WE, Tomlinson LA, Ferro CJ, Steeds RP, Mark PB, Zehnder D, et al. Effect of a reduction in glomerular filtration rate after NEphrectomy on arterial STiffness and central hemodynamics: rationale and design of the EARNEST study. Am Heart J. 2014 Feb;167(2):141–9.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kendi Celebi Z, Peker A, Kutlay S, Kocak S, Tuzuner A, Erturk S, et al. Effect of unilateral nephrectomy on urinary angiotensinogen levels in living kidney donors: 1 year follow-up study. J Renin-Angiotensin-Aldosterone Syst. 2017 Oct-Dec;18(4):1470320317734082.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Yildirim M, Karahan M, Kucuk HF, Demir T, Demir H, Turan H, et al. Increased oxidative stress in living kidney donors: correlation of renal functions with antioxidant capacity. Transplant Proc. 2017 Apr;49(3):407–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Cantarelli C, Cravedi P. Criteria for living donation from marginal donors: one, no one, and one hundred thousand. Nephron. 2019;142(3):227–32.CrossRefPubMedGoogle Scholar
  21. 21.
    European Renal Best Practice Transplantation Guideline Development Group. ERBP Guideline on the management and evaluation of the kidney donorand recipient. Nephrol Dial Transplant. 2013 Aug;28(Suppl 2):1–71.CrossRefGoogle Scholar
  22. 22.
    System UR. USRDS 2013 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. National Institute of Diabetes and Digestive: National Institutes of Health; 2013.Google Scholar
  23. 23.
    Al Ammary F, Luo X, Muzaale AD, Massie AB, Crews DC, Waldram MM, et al. Risk of ESKD in older live donors with hypertension. Clin J Am Soc Nephrol. 2019 Jul 5;14(7):1048–55.CrossRefPubMedGoogle Scholar
  24. 24.
    Segev DL, Muzaale AD, Caffo BS, Mehta SH, Singer AL, Taranto SE, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010 Mar 10;303(10):959–66.CrossRefPubMedGoogle Scholar
  25. 25.
    Textor SC, Taler SJ, Driscoll N, Larson TS, Gloor J, Griffin M, et al. Blood pressure and renal function after kidney donation from hypertensive living donors. Transplantation. 2004 Jul 27;78(2):276–82.CrossRefPubMedGoogle Scholar
  26. 26.
    Clayton PA, Saunders JR, McDonald SP, Allen RD, Pilmore H, Saunder A, et al. Risk-factor profile of living kidney donors: the Australia and new Zealand Dialysis and transplant living kidney donor registry 2004-2012. Transplantation. 2016 Jun;100(6):1278–83.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of NephrologyBahcesehir UniversityIstanbulTurkey
  2. 2.Bahcesehir University Medical SchoolIstanbulTurkey

Personalised recommendations