Mid- and long-term health risks in living kidney donors: a systematic review and meta-analysis. British Transplantation Society / Renal Association . 1992;36(4):33945. This has recently been facilitated by the development of an online tool (www.transplantmodels.com/esrdrisk) which provides a 15-year and lifetime pre-donation risk of ESRD in prospective donors, which was based on a meta-analysis of data from nearly 5 million healthy individuals, similar to kidney donor candidates, from general population cohorts [34]. Rule AD, Amer H, Cornell LD, Taler SJ, Cosio FG, Kremers WK, Textor SC, Stegall MD. 1. Age- and gender-specific normal GFR reference ranges based on measured GFRs from 2974 prospective living kidney donors, Age- and gender-specific GFR reference ranges based on measured GFRs from 2974 prospective living kidney donors. (DOCX 258kb). A large multi-centre observational cohort study with prospective recruitment of potential living kidney donors, incorporating baseline and longitudinal demographic and bioclinical data with a standardized method for mGFR and other renal phenotyping would be desirable to provide robust data on the effects of age, gender, and ethnicity on GFR. The current BNMS guideline quotes a reference range based on a series of mGFRs in 503 healthy subjects published in 1981: mean GFR in young adults was 105mL/min/1.73m2 which declined by 4mL/min/1.73m2 per decade up to 50years of age, and 10mL/min/1.73m2 per decade thereafter [2, 3]. Further, we describe how our GFR reference ranges can be used to inform minimum thresholds of GFR considered safe for prospective living kidney donors to proceed to nephrectomy. Nephron Physiol. Emma Montgomery, Email: ten.shn@yremogtnomamme. These equations are valid only with standardized creatinine and cystatin methods. An age-related decline in GFR, which was faster in females, was confirmed in a subgroup of prospective donors selected on the basis of no proteinuria, normal renal imaging, and normal differential kidney function. Previous studies have suggested that the risk of ESRD after living kidney donation is not higher than in the general population [27, 28], but there is a small absolute increased risk [29,30,31]. Previous studies have suggested that the risk of ESRD after living kidney donation is not higher than in the general population [27, 28], but there is a small absolute increased risk [2931]. Cherikh WS, Young CJ, Kramer BF, Taranto SE, Randall HB, Fan PY. Reference ranges for GFR were created using segmented multiple linear regression incorporating the amalgamated data from all 18 centres to model mGFR as a function of age and gender. Figure S2. This leads to a convex curve in the . It should also be noted that men younger than 55years and women younger than 50years could have a GFR below the lower limit of their reference range but still 60mL/min/1.73m2 and so, in the absence of another marker of renal disease, would be missed by the current definition of CKD. Ann Intern Med. Age- and gender-specific GFR reference ranges were determined by segmented multiple linear regression and presented as means two standard deviations. However, whilst threshold GFRs provide useful guidance to clinicians assessing prospective living kidney donors, individualised decision-making is important, especially in cases where GFR may be just below the recommended advisory threshold, or where there are compounding risk factors for ESRD. We would like to acknowledge Elsie Lanchbury and Chris Boivin from the Department of Nuclear Medicine, University Hospitals Birmingham NHS Foundation Trust, for their contributions to discussions and help with collecting data. As in the total cohort of prospective donors, mGFR in the subgroup declined with age and the GFR decline after 35years of age was more rapid in females. Therefore, 721 prospective donors from our three centres were included in the subgroup analysis and their baseline characteristics are presented in Additional file 1: Table S1. (PDF) Glomerular filtration rate: new age- and gender- specific Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK, Department of Renal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK, Wolfson Computer Laboratory, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK, Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK, Department of Renal Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK, You can also search for this author in All authors read and approved the final manuscript. Mjoen G, Hallan S, Hartmann A, Foss A, Midtvedt K, Oyen O, Reisaeter A, Pfeffer P, Jenssen T, Leivestad T, et al. Read more about the task force here. It is important to have accurate reference ranges for GFR. Refer to the table below for population mean estimated GFR for a number of age ranges. . New York: Oxford University Press; 1951. p. 52074. The tracer used was 51Cr-EDTA in our three centres and in all of the other 15 centres apart from one which used 99mTc-DTPA. Ethnic and gender related differences in the risk of end-stage renal disease after living kidney donation. The purpose of this study was to use a large, contemporary, multi-centre series of mGFRs from healthy individuals to determine age- and gender-specific reference ranges. Several theories have been proposed to explain the more rapid GFR decline seen in females. A normal probability plot was used to confirm the validity of the assumption that the residuals were from a Normal distribution. Drug dosing decisions should generally be based on non-indexed eGFR value. Delanaye P, Glassock RJ, Pottel H, Rule AD. Int Urol Nephrol. British Transplantation Society / Renal Association. Garg AX, Muirhead N, Knoll G, Yang RC, Prasad GV, Thiessen-Philbrook H, Rosas-Arellano MP, Housawi A, Boudville N, Donor Nephrectomy Outcomes Research N. Proteinuria and reduced kidney function in living kidney donors: a systematic review, meta-analysis, and meta-regression. Glomerular filtration rate: new age- and gender- specific reference ranges and thresholds for living kidney donation. Definition Human Kidneys The incorporation of genetic ancestry data instead of race resulted in similar estimates of the GFR (median difference, 1.33 ml per minute per 1.73 m 2; 95% CI, 0.12 to 2.33; P 10, 42%; 95% CI . Slinin Y, Brasure M, Eidman K, Bydash J, Maripuri S, Carlyle M, Ishani A, Wilt TJ. O'Keeffe LM, Ramond A, Oliver-Williams C, Willeit P, Paige E, Trotter P, Evans J, Wadstrm J, Nicholson M, Collett D, et al. Do healthy potential kidney donors in India have an average glomerular filtration rate of 81.4 ml/min? Figure S2. Finally, we did not have ethnicity data, which would have allowed us to validate previous work which has suggested that individuals of Asian ethnicity have a lower GFR [20, 40, 41]. Kidney Int. This study does not meet the Health Research Authority criteria for research requiring NHS REC approval and therefore ethics approval was not necessary. 2009;75(10):107987. A large multi-centre observational cohort study with prospective recruitment of potential living kidney donors, incorporating baseline and longitudinal demographic and bioclinical data with a standardized method for mGFR and other renal phenotyping would be desirable to provide robust data on the effects of age, gender, and ethnicity on GFR. We aimed to address this and to use the ranges to provide age- and gender-specific advisory GFR thresholds considered acceptable for living kidney donation. The 'ideal' study to define 'normal' GFR values would be a study with the following characteristics: the sample must be of sufficient size and representative of the general population (according to age, gender and ethnicity), the healthy status of the sample must be unquestionable, the method used to measure GFR must be accurate and the . The .gov means its official. Those with missing data in any of these three variables were also excluded. Your support helps families facing kidney disease at every step of their journey. All 18 centres adhered to the BNMS guidelines for the measurement of GFR [2]. In: Smith HW, editor. AF, PN, and MP participated in data analysis. Indeed, previous work has shown that there is considerable variation in GFR decline with age [14, 39]. Glomerular filtration rate: new age- and gender- specific reference ranges and thresholds for living kidney donation, https://doi.org/10.1186/s12882-018-1126-8, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Whether or not ethnicity is a determinant of GFR is an important question which requires further study in large, ethnically diverse cohorts, with accurate measures of GFR. In 2974 prospective living kidney donors from 18 UK centres, we found that young adults had an mGFR of approximately 100mL/min/1.73m2 until 35years of age, following which there was a linear decline that was faster in females. These data were amalgamated with individual-level data from 1878 prospective donors from the 15 other UK renal centres, producing a dataset for 2974 prospective donors from 18 centres. The tracer used was 51Cr-EDTA in our three centres and in all of the other 15 centres apart from one which used 99mTc-DTPA. Am J Kidney Dis. The implications of anatomical and functional changes of the aging kidney: with an emphasis on the glomeruli. Brochner-Mortensen J. Another consequence of using prospective kidney donors was that there were relatively few individuals in the cohort over 70years of age, and this is to be borne in mind when interpreting our GFR reference ranges in this age group. Second, as females age, the impact of oestrogens on renal haemodynamics and structure are lost due to a gradual decline in oestrogen levels even before the menopause [2325]. The aging kidney - UpToDate Glomerular filtration rate (GFR) is the best overall index of kidney function. You may have kidney disease if your GFR number is: Below 60 for three months Normal GFR values observed in young healthy adult populations are approximately 100-110 mL/min/1.73m 2, . Hallan SI, Matsushita K, Sang Y, Mahmoodi BK, Black C, Ishani A, Kleefstra N, Naimark D, Roderick P, Tonelli M, et al. All 18 centres adhered to the BNMS guidelines for the measurement of GFR [2]. Choosing "Yes" will bring up fields to input height and weight. Mean GFRtwo SDs for the subgroup are shown in Additional file 1: Table S2 and Figure S1. AF, EM, PN, MP, NS, CW, and GL participated in the performance of the research. We recommended an advisory threshold GFR of >80mL/min/1.73m2 for prospective donors aged 3045, because this appears safe based on long-term outcome studies showing only a very small absolute increased risk of ESRD in cohorts of donors with this level of renal function and in this age range [30, 31].
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