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Abstract: SA-OR67

Suitability to Donate and Attitude Toward Living Kidney Donation in Older Adults: Results from the BIS Study

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Villain, Cédric, Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
  • Gill, John S., Division of Nephrology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
  • Mielke, Nina, Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
  • Bothe, Tim, Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
  • Barghouth, Muhammad, Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
  • Pöhlmann, Anna, Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
  • Fietz, Anne-Katrin, Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
  • Ebert, Natalie, Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
  • Schaeffner, Elke, Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
Background

Guidelines differ regarding thresholds of glomerular filtration rate (GFR) and albuminuria (ACR) to accept living kidney donation (LKD). We aimed to assess the proportion of community-dwelling older adults suitable to LKD according to different GFR and ACR thresholds, and their attitude towards LKD.

Methods

We used data from the BIS-study, a cohort of adults aged ≥70 years. Kidney-related contraindications to LKD were defined using KDIGO (high and low GFR thresholds of 90 and 60ml/min/1.73m2 using the EKFC equation based on creatinine and cystatin C, respectively; LKD can be discussed between these thresholds) and British Transplantation Society (BTS; age- and sex-specific GFR thresholds) guidelines. The ACR thresholds were 30mg/g (low threshold for both guidelines), 100mg/g (high KDIGO threshold), and 300mg/g (high BTS threshold). Participants’ attitude towards LKD was asked at the first follow-up visit.

Results

Among the 2069 participants (median age 80 years, 53% women, median estimated GFR 63ml/min/1.73m2), none had an estimated GFR above the high KDIGO GFR threshold at baseline. Considering the combination of other GFR and ACR thresholds, prevalence of renal contraindication to LKD ranged from 38 to 54%. Ninety-three percent of participants presented ≥1 non-kidney-related contraindication to LKD, among which heart failure, coronary artery disease, and cancer were the most frequent. Prevalence of suitability to LKD ranged from 0 to 6%, depending on combinations of thresholds of GFR and ACR. After an 8-year follow-up period, 11 to 16% of participants suitable to LKD at baseline maintained their suitability criteria, 6 to 11% had died, and none of them developed CKD stage 4-5. Overall, 73% of all participants agreed to donate a kidney to a relative, but this percentage rose to 85 to 87% in participants suitable to LKD.

Conclusion

Most older adults were theoretically willing to donate a kidney to a relative. Regardless of the low percentage of participants without any contraindication to LKD, their absolute sample size could be an opportunity to increase the number of kidney donors at the population level. To this purpose, the choice of GFR and ACR thresholds may be crucial.

Funding

  • Government Support – Non-U.S.