Risk factors for lower renal compensation after nephrectomy: an analysis of living kidney donors in an Amazonian cohort

Ferreira, Luan Moraes; Batista, Gisela Gomes; Bouillet, Leoneide Érica Maduro; Esposito, Emanuel Pinheiro

doi:10.1590/2175-8239-JBN-2023-0134en

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Brazilian Journal of Nephrology

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Sumário

ORIGINAL ARTICLE • Braz. J. Nephrol. 46 (3) • Jul-Sep 2024 • https://doi.org/10.1590/2175-8239-JBN-2023-0134en copy

Risk factors for lower renal compensation after nephrectomy: an analysis of living kidney donors in an Amazonian cohort

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Living donor kidney transplantation is considered the ideal renal replacement therapy because it has a lower complication rate and allows an efficient response to the high demand for grafts in the healthcare system. Careful selection and adequate monitoring of donors is a key element in transplantation. Individuals at greater risk of developing kidney dysfunction after nephrectomy must be identified.

Objective:

To identify risk factors associated with a renal compensation rate (CR) below 70% 12 months after nephrectomy.

Methods:

This observational retrospective longitudinal study included living kidney donors followed up at the Lower Amazon Regional Hospital between 2016 and 2022. Data related to sociodemographic variables, comorbid conditions and kidney function parameters were collected.

Results:

The study enrolled 32 patients. Fourteen (43.75%) had a CR < 70% 12 months after kidney donation. Logistic regression found obesity (Odds Ratio [95%CI]: 10.6 [1.7–65.2]), albuminuria (Odds Ratio [95%CI]: 2.41 [1.2–4.84]) and proteinuria (Odds Ratio [95%CI]: 1.14 [1.03–1.25]) as risk factors. Glomerular filtration rate was a protective factor (Odds Ratio [95% CI]: 0.92 [0.85–0.99]).

Conclusion:

Obesity, albuminuria and proteinuria adversely affected short-term renal compensation rate. Further studies are needed to uncover the prognostic implications tied to these risk factors. Our findings also supported the need for careful individualized assessment of potential donors and closer monitoring of individuals at higher risk.

Keywords:
Kidney Transplantation; Living Donors; Obesity; Albuminuria; Proteinuria

Variable	Frequency
Gender (n, %)
*Male*	*17 (53.2)*
*Female*	*15 (46,8)*
Age (mean, ±SD)	*40.9 (± 8.8)*
Race (n, %)
*White*	*2 (6.2)*
*Brown*	*29 (90.6)*
*Black*	*1 (3.1)*
Co-morbities (n, %)
*Obesity*	*10 (31.2)*
*High blood pressure*	*3 (9.3)*
*Dyslipidemia*	*1 (3.1)*
*Tobacco use*	*5 (15.6)*
*Alcoholism*	*5 (15.6)*
Arterial blood pressure (mean, ± SD)
*Systolic pressure*	*119.6 (± 9.6)*
*Diastolic pressure*	*76.7 (± 5.4)*
*Mean arterial pressure*	*90.9 (± 6.1)*
Pre-nephrectomy renal function (mean, ± SD)
*Creatinine mg/dL*	*0.86 (± 0.14)*
*GFR (CKD-EPI 2021)*	*104 (± 12.3)*
*Albuminuria mg/24 hours*	*8.5 (± 5.5)*
*Proteinuria mg/24 hours*	*58.3 (± 31.9)*
Renal function after 12 months (mean, ± SD)
*Creatinine mg/dL*	*1.2 (± 0.24)*
*GFR (CKD-EPI 2021)*	*69.8 (± 16.8)*
*Albuminuria mg/24 hours*	*10.8 (± 5)*
*Proteinuria mg/24 hours*	*79.5 (± 33.7)*
*Renal function CR* (%, ±)	*69.5% (± 10.3)*
TOTAL (n)	32

Variable	Total
Variable	Group α – renal function CR < 70%	Grupo β – renal function CR > 70%	p value
Gender (n, %)
*Male*	*7 (50)*	*10 (55.5)*	*0.95*
*Female*	*7 (50)*	*8 (44.4)*	*0.95*
Age (mean, ± SD)	*42.5 (± 9.2)*	*39.7 (± 8.4)*	*0.18*
Race (n, %)
*White*	*1 (7.1)*	*1 (5.5)*	*0.98*
*Brown*	*12 (85.7)*	*17 (94.4)*
*Black*	*1 (7.1)*	0
Co-morbities (n, %)
*Obesity*	*8 (57.1)*	*2 (11.1)*	*0.005*
*High blood presure*	*2 (14.2)*	*1 (5.5)*	*0.4*
*Dyslipidemia*	*1 (4.1)*	0	*N.A.*
*Tobacco use*	*3 (21.4)*	*2 (11.1)*	*0.3*
*Alcoholism*	*3 (21.4)*	*2 (11.1)*	*0.3*
Arterial blood pressure (mean, ± SD)
*Systolic pressure*	*120.7 (± 9.9)*	*118 (± 9.6)*	*0.3*
*Diastolic pressure*	*78.5 (± 5.3)*	*75.5 (± 5.1)*	*0.05*
*Mean arterial pressure*	*92.5 (± 6.6)*	*89.6 (± 5.6)*	*0.09*
Pre-nephrectomy renal function (mean, ± SD)
*Creatinine mg/dL*	*0.87 (± 0.25)*	*0.85 (± 0.14)*	*0.3*
*GFR (CKD-EPI 2021)*	*96.8 (± 20.7)*	*107.8 (± 10.7)*	*0.02*
*Albuminuria mg/24 hours*	*12.6 (± 5.7)*	*5.3 (± 2.4)*	*0.0002*
*Proteinuria mg/24 hours*	*67.3 (± 43.2)*	*37.5 (± 13.4)*	*< 0.0001*
Renal function after 12 months (mean, ± SD)
*Creatinine mg/dL*	*1.32 (± 0.26)*	*1.08 (± 0.16)*	*0.001*
*GFR (CKD-EPI 2021)*	*60.4 (± 8.9)*	*83 (± 12.06)*	*< 0.0001*
*Albuminuria mg/24 hours*	*14.2 (± 5.7)*	*8.2 (± 2.2)*	*0.0009*
*Proteinuria mg/24 hours*	*110.4 (± 28.6)*	*55.5 (± 12.1)*	*< 0.0001*
*Renal function CR* (%, ± SD)	*60.8% (± 8.1)*	*76.3% (± 5.6)*	*< 0.0001*
TOTAL (n)	14	18

Variable	Odds Ratio (IC 95%)	p value
Male gender	*0.8 (0.19–3.2)*	*0.96*
Obesity	*10.6 (1.7–65.2)*	**0.01^ * Statistically significant value. GFR: glomerular filtration rate. Source: The authors, 2023.***
Initial GFR	*0.92 (0.85–0.99)*	**0.01^ * Statistically significant value. GFR: glomerular filtration rate. Source: The authors, 2023.***
Albuminuria	*2.41 (1.2–4.84)*	**< 0.0001^ * Statistically significant value. GFR: glomerular filtration rate. Source: The authors, 2023.***
Proteinuria	*1.14 (1.03–1.25)*	**< 0.0001^ * Statistically significant value. GFR: glomerular filtration rate. Source: The authors, 2023.***
Age	*1.03 (0.95–1.12)*	*0.35*
Mean arterial pressure	*1.08 (0.96–1.23)*	*0.16*

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[1] Correspondence to: Emanuel Pinheiro Esposito. Email: espositodr@hotmail.com