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Kidney Week

Abstract: TH-PO1170

Low GFR in Healthy Individuals Is an Important Factor Preventing Kidney Transplantation from Living Kidney Donors in India

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Parameswaran, Sreejith, JIPMER, Ponidcherry, India
  • H, Satish, JIPMER, Ponidcherry, India
  • Manikandan, Ramanitharan, JIPMER, Ponidcherry, India
  • S, Priyamvada P., JIPMER, Ponidcherry, India
  • Radhakrishnan, Jai, Columbia University Medical Center, New York, New York, United States
Background

More than 80% kidney transplantation (KT) are from Living Kidney Donors (LKD) in India. There are no validated equation for GFR estimation or CKD risk prediction in Indians, making the use of GFR criteria for accepting LKD problematic. Previous studies using inulin clearance have demonstrated relatively low GFR in healthy LKDs in India. How often LKDs are found unfit to donate based on GFR criteria is unknown.

Methods

A LKD database was created in 2012 & data were collected prospectively using a pre-defined data collection form. Screening evaluation include blood group, history taking with pre-specified data points, measurement of BMI & BP & lab tests (Serum creatinine, fasting & postprandial blood glucose, lipid profile and Urine R/E) & LKD having no abnormalities on screening were enrolled in the database & evaluated further. A minimum GFR (by DTPA renogram - multiple plasma sampling technique) of 70ml/minute/1.73m2 was necessary for a LKD to be accepted for kidney donation. All LKDs registered for KT from 1st January 2012 to 31st December 2018 were included in the analysis.

Results

A total of 316 LKDs were evaluated during the study period, with mean age of 44.11 (±10.85) years & 253 (80%) were females. 274 (89.5%) of our LKDs were 'Below Poverty Line (BPL)', with family income less than INR 2000 ($28) per month. Only 101 (33%) ESRD - LKD pairs initiated on evaluation eventually underwent KT. On 92 instances factors related to the LKD prevented the KT. Low GFR (n=40, 43.5%) and impaired OGTT (n=12, 13%) were the major LKD factors precluding KT, along with withdrawal of consent (n=18, 19.5%). 40 LKDs found to have GFR <70ml/minute/1.73m2 were rejected as VKD. None of them had hypertension or any other abnormality on evaluation. In a subset of LKD studied, the average protein intake estimated by urine Urea Nitrogen excretion was 0.6gm/kg/day & Renal Reserve Study done by IV Amino Acid infusion showed an average rise by 34.6% in GFR; with GFR >70ml/minute/1.73m2 in 75% of LKDs who had baseline GFR <70ml/minute/1.73m2

Conclusion

Only one third of LKD were eventually able to donate their kidney. Low GFR in otherwise healthy LKDs was an important reason precluding KT. The low baseline GFR may be related to low dietary protein intake, as suggested by significant renal reserve.

Funding

  • Government Support - Non-U.S.