Estimated glomerular filtration rate for longitudinal follow-up of living kidney donors

Abstract

Background Living kidney donor safety requires reliable long-term follow-up of renal function after donation. The current study aimed to define the precision and accuracy of post-donation estimated glomerular filtration rate (EGFR) slopes compared with measured GFR (mGFR) slopes. Methods In 349 donors (age 51 ± 10, 54% female), we analysed EGFR according to the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault/body surface area (CG/BSA), creatinine clearance (CrCl) and mGFR (125 I-iothalamate) changes from 3 months until 5 years post-donation. Results Donors had a pre-donation mGFR of 116 ± 23 mL/min, at 3 months post-donation mGFR was 73± 14 mL/min and at 5 years it was 79 ± 16 mL/min. Between 3 months and 5 years post-donation, 28% of donors had a declining mGFR (-0.82 ± 0.79 mL/min/year), 47% were stable and 25% had an increasing mGFR. Overall, EGFR equations showed good slope estimates (bias EGFR CKD-EPI 0.13 ± 2.16 mL/min/year, EGFR MDRD 0.19 ± 2.10 mL/min/year, EGFR CG/BSA -0.08 ± 2.06 mL/min/year, CrCl -0.12 ± 4.75 mL/min/year), but in donors with a decreasing mGFR the slope was underestimated (bias EGFR CKD-EPI 1.41 ± 2.03 mL/min/year, EGFR MDRD 1.51 ± 1.96 mL/min/year, EGFR CG/BSA 1.20 ± 1.87 mL/min/year). The CrCl had a high imprecision [bias interquartile range -1.51-3.41 mL/min/year]. Conclusions All EGFR equations underestimated GFR slopes in donors with a declining GFR between 3 months and 5 years post-donation. This study underlines the value of mGFR in the follow-up of donors with risk of progressive GFR loss.