Proteinuria and reduced kidney function in living kidney donors: A systematic review, meta-analysis, and meta-regression.
We reviewed any study where 10 or more healthy adults donated a kidney, and proteinuria, or glomerular filtration rate (GFR) was assessed at least 1 year later. Bibliographic databases were searched until November 2005. 31 primary authors provided additional information. Forty-eight studies from 27 countries followed a total of 5048 donors. An average of 7 years after donation (range 1-25 years), the average 24 h urine protein was 154 mg/day and the average GFR was 86 ml/min. In eight studies which reported GFR in categories, 12% of donors developed a GFR between 30 and 59 ml/min (range 0-28%), and 0.2% a GFR less than 30 ml/min (range 0-2.2%). In controlled studies urinary protein was higher in donors and became more pronounced with time (three studies totaling 59 controls and 129 donors; controls 83 mg/day, donors 147 mg/day, weighted mean difference 66 mg/day, 95% confidence interval (CI) 24-108). An initial decrement in GFR after donation was not accompanied by accelerated losses over that anticipated with normal aging (six studies totaling 189 controls and 239 donors; controls 96 ml/min, donors 84 ml/min, weighted mean difference 10 ml/min, 95% CI 6-15; difference not associated with time after donation (P=0.2)). Kidney donation results in small increases in urinary protein. An initial decrement in GFR is not followed by accelerated losses over a subsequent 15 years. Future studies will provide better estimates, and identify those donors at least risk of long-term morbidity.
Garg
A X
AX
Division of Nephrology, University of Western Ontario, London, Ontario, Canada. amit.garg@lhsc.on.ca
Muirhead
N
N
Knoll
G
G
Yang
R C
RC
Prasad
G V R
GV
Thiessen-Philbrook
H
H
Rosas-Arellano
M P
MP
Housawi
A
A
Boudville
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000502:physiology; D019520:Living Donors; D008875:Middle Aged; D009392:Nephrectomy; D017063:Outcome Assessment, Health Care; D011507:Proteinuria / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D051437:Renal Insufficiency / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D012307:Risk Factors