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Visceral obesity in Asian living kidney donors significantly impacts early renal function after donor nephrectomy

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A Letter to the Editor to this article was published on 08 September 2020

Abstract

Introduction

Obesity may be a risk factor for kidney donors to develop reduced renal function. The Framingham heart study suggested that visceral adipose tissue (VAT) confers a more adverse metabolic profile compared with subcutaneous adipose tissue (SAT). Asians tend to have a higher VAT composition and it is unclear if their kidney function is affected differently. We hypothesized that Asian living kidney donors who have visceral obesity are at a higher risk of renal function deterioration 1 year after donation.

Methods

Between 2011 and 2014, we retrospectively evaluated data from 73 consecutive patients (52% male; mean age 44.9 ± 11.7 years) before they underwent donor nephrectomy and at their 1 year routine follow-up. VAT and SAT were measured at the level of the umbilicus on pre-operative computerized tomography (CT). Visceral obesity (VO) was defined as a VAT > 100 cm [2] and patients were then further divided and compared in two subgroups: VAT > 100 and < 100 cm [2]. Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m [2]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation pre-operatively and 1 year post-operatively.

Results

Both subgroups had similar baseline kidney function (P = NS) pre-operatively. At the 1 year follow-up, patients with VO experienced a more significant decline of renal function (109 ± 9 to 89 ± 8 mL/min per 1.73 m2), compared to those without VO (111 ± 12 to 96 ± 11 mL/min per 1.73 m2, P = 0.013). VO was associated with a body mass index (BMI) > 25 kg/m2 (P < 0.001), male gender (P < 0.001) and older age at the time of donor nephrectomy (48.0 vs 39.5 years, P = 0.01). The presence of hypertension or hyperlipidaemia pre-operatively, choice of surgical approach, and post-operative complication rates, did not differ significantly between the subgroups.

Conclusions

Visceral obesity as defined by VAT > 100 cm2 at the level of the umbilicus on cross-sectional imaging, may have a significant impact on early renal function after donor nephrectomy. Adiposity markers, as measured by cross-sectional CT imaging, may be incorporated into routine pre-operative kidney donor workup.

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Authors and Affiliations

  1. National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore

    Gregory Xiang Wen Pek, Clara Lee Ying Ngoh, Boon Wee Teo, Anantharaman Vathsala, Benjamin Yen Seow Goh, Clement Hsiang Rong Yong, Lata Raman & Ho Yee Tiong

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  1. Gregory Xiang Wen Pek
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  2. Clara Lee Ying Ngoh
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Contributions

XP: data collection, data collection and analysis, manuscript writing. LYCN: data collection, data analysis. BWT: protocol/project development, data management. AV: protocol/project development, data management, manuscript editing. YSBG: data management, data analysis. CY: data collection, data analysis. LR: data management, data analysis. HYT: protocol/project development, data collection and management, data analysis, manuscript editing.

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Correspondence to Ho Yee Tiong.

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The authors declare they have no conflict of interest.

Informed consent

Informed consent was taken, and the data were collected according to an approved institutional review board protocol (DSRB reference no: 2016/01304).

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No human or animal testing was performed.

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Pek, G.X.W., Ngoh, C.L.Y., Teo, B.W. et al. Visceral obesity in Asian living kidney donors significantly impacts early renal function after donor nephrectomy. World J Urol 37, 2231–2236 (2019). https://doi.org/10.1007/s00345-018-2566-2

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  • DOI: https://doi.org/10.1007/s00345-018-2566-2

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