elderly; glomerular filtration rate; living kidney donors
Abstract :
[en] OBJECTIVES: Most data on glomerular filtration rate (GFR) originate from subjects <65 years old, complicating decision-making in elderly living kidney donors. In this retrospective multi-center study, we calculated percentiles of measured GFR (mGFR) in donors <65 years old and extrapolated these to donors ≥65 years old. METHODS: mGFR percentiles were calculated from a development cohort of French/Belgian living kidney donors <65 years (n=1,983), using quantiles modeled as cubic splines (two linear parts joining at 40 years). Percentiles were extrapolated and validated in an internal cohort of donors ≥65 years (n=147, France) and external cohort of donors and healthy subjects ≥65 years (n=329, Germany, Sweden, Norway, France, The Netherlands) by calculating percentages within the extrapolated 5th-95th percentile (P5-P95). RESULTS: Individuals in the development cohort had a higher mGFR (99.9 ± 16.4 vs. 86.4 ± 14 and 82.7 ± 15.5 mL/min/1.73 m(2)) compared to the individuals in the validation cohorts. In the internal validation cohort, none (0%) had mGFR below the extrapolated P5, 12 (8.2%) above P95 and 135 (91.8%) between P5-P95. In the external validation cohort, five subjects had mGFR below the extrapolated P5 (1.5%), 25 above P95 (7.6%) and 299 (90.9%) between P5-P95. CONCLUSIONS: We demonstrate that extrapolation of mGFR from younger donors is possible and might aid with decision-making in elderly donors.
Disciplines :
Urology & nephrology Laboratory medicine & medical technology
Author, co-author :
DELANAYE, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie
Gaillard, François
van der Weijden, Jessica
Mjøen, Geir
Ferhman-Ekholm, Ingela
Dubourg, Laurence
Ebert, Natalie
Schaeffner, Elke
Åkerfeldt, Torbjörn
Goffin, Karolien
Couzi, Lionel
Garrouste, Cyril
Rostaing, Lionel
Courbebaisse, Marie
Legendre, Christophe
Hourmant, Maryvonne
Kamar, Nassim
Cavalier, Etienne ; Université de Liège - ULiège > Département de pharmacie > Chimie médicale
WEEKERS, Laurent ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie
BOUQUEGNEAU, Antoine ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie
Pottel, H, Hoste, L, Yayo, E, Delanaye, P. Glomerular filtration rate in healthy living potential kidney donors: A meta-Analysis. Nephron 2017;135:105-19. https://doi.org/10.1159/000450893.
Poggio, ED, Rule, AD, Tanchanco, R, Arrigain, S, Butler, RS, Srinivas, T, et al. Demographic and clinical characteristics associated with glomerular filtration rates in living kidney donors. Kidney Int 2009;75:1079-87. https://doi.org/10.1038/ki.2009.11.
Barai, S, Bandopadhayaya, GP, Patel, CD, Rathi, M, Kumar, R, Bhowmik, D, et al. Do healthy potential kidney donors in India have an average glomerular filtration rate of 81.4 ml/min? Nephron Physiol 2005;101:21-6. https://doi.org/10.1159/000086038.
Jafar, TH, Islam, M, Jessani, S, Bux, R, Inker, LA, Mariat, C, et al. Level and determinants of kidney function in a South Asian population in Pakistan. Am J Kidney Dis 2011;58:764-72. https://doi.org/10.1053/j.ajkd.2011.06.012.
Denic, A, Mathew, J, Lerman, LO, Lieske, JC, Larson, JJ, Alexander, MP, et al. Single-nephron glomerular filtration rate in healthy adults. N Engl J Med 2017;376:2349-57. https://doi.org/10.1056/nejmoa1614329.
Gaillard, F, Courbebaisse, M, Kamar, N, Rostaing, L, Del Bello, A, Girerd, S, et al. The age-calibrated measured glomerular filtration rate improves living kidney donation selection process. Kidney Int 2018;94:616-24. https://doi.org/10.1016/j.kint.2018.05.016.
Delanaye, P, Jager, KJ, Bökenkamp, A, Christensson, A, Dubourg, L, Eriksen, BO, et al. CKD: A call for an age-Adapted definition. J Am Soc Nephrol 2019;30:1785-805. https://doi.org/10.1681/asn.2019030238.
Eriksen, BO, Palsson, R, Ebert, N, Melsom, T, van der Giet, M, Gudnason, V, et al. GFR in healthy aging: An individual participant data meta-Analysis of iohexol clearance in European population-based cohorts. J Am Soc Nephrol 2020;31:1602-15. https://doi.org/10.1681/asn.2020020151.
Pottel, H, Delanaye, P, Weekers, L, Selistre, L, Goffin, K, Gheysens, O, et al. Age-dependent reference intervals for estimated and measured glomerular filtration rate. Clin Kidney J 2017;10:545-51. https://doi.org/10.1093/ckj/sfx026.
Fehrman-Ekholm, I, Skeppholm, L. Renal function in the elderly (>70 years old) measured by means of lohexol clearance, serum creatinine, serum urea and estimated clearance. Scand J Urol Nephrol 2004;38:73-7. https://doi.org/10.1080/00365590310015750.
Al Ammary, F, Bowring, MG, Massie, AB, Yu, S, Waldram, MM, Garonzik-Wang, J, et al. The changing landscape of live kidney donation in the United States from 2005 to 2017. Am J Transplant 2019;19:2614-21. https://doi.org/10.1111/ajt.15368.
Gaillard, F, Jacquemont, L, Roberts, V, Albano, L, Allard, J, Bouvier, N, et al. Temporal trends in living kidney donation in France between 2007 and 2017. Nephrol Dial Transplant 2021;36:730-8. https://doi.org/10.1093/ndt/gfz229.
Gaillard, F, Courbebaisse, M, Kamar, N, Rostaing, L, Jacquemont, L, Hourmant, M, et al. Impact of estimation versus direct measurement of predonation glomerular filtration rate on the eligibility of potential living kidney donors. Kidney Int 2019;95:896-904. https://doi.org/10.1016/j.kint.2018.11.029.
Schaeffner, ES, Ebert, N, Delanaye, P, Frei, U, Gaedeke, J, Jakob, O, et al. Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med 2012;157:471-81. https://doi.org/10.7326/0003-4819-157-7-201210020-00003.
Dubourg, L, Lemoine, S, Joannard, B, Chardon, L, De Souza, V, Cochat, P, et al. Comparison of iohexol plasma clearance formulas vs. inulin urinary clearance for measuring glomerular filtration rate. Clin Chem Lab Med 2020;59:571-9. https://doi.org/10.1515/cclm-2020-0770.
Mjoen, G, Hallan, S, Hartmann, A, Foss, A, Midtvedt, K, Oyen, O, et al. Long-Term risks for kidney donors. Kidney Int 2014;86:162-7. https://doi.org/10.1038/ki.2013.460.
Apperloo, AJ, de Zeeuw, D, Donker, AJ, de Jong, PE. Precision of glomerular filtration rate determinations for long-Term slope calculations is improved by simultaneous infusion of 125I-iothalamate and 131I-hippuran. J Am Soc Nephrol 1996;7:567-72. https://doi.org/10.1681/asn.v74567.
Soveri, I, Berg, UB, Björk, J, Elinder, C-GG, Grubb, A, Mejare, I, et al. Measuring GFR: A systematic review. Am J Kidney Dis 2014;64:411-24. https://doi.org/10.1053/j.ajkd.2014.04.010.
Gaillard, F, Legendre, C, White, CA. GFR assessment of living kidney donors candidates. Transplantation 2019;103:1086-93. https://doi.org/10.1097/tp.0000000000002620.
Shock, NW. Kidney function tests in aged males. Geriatrics 1946;1:232-9.
Garg, N, Lentine, KL, Inker, LA, Garg, AX, Rodrigue, JR, Segev, DL, et al. The kidney evaluation of living kidney donor candidates: US practices in 2017. Am J Transplant 2020;20:3379-89. https://doi.org/10.1111/ajt.15951.
Lindeman, RD, Tobin, J, Shock, NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 1985;33:278-85. https://doi.org/10.1111/j.1532-5415.1985.tb07117.x.
Delanaye, P, Schaeffner, E, Ebert, N, Cavalier, E, Mariat, C, Krzesinski, J-MM, et al. Normal reference values for glomerular filtration rate: what do we really know? Nephrol Dial Transplant 2012;27:2664-72. https://doi.org/10.1093/ndt/gfs265.
Glassock, RJ. Con: Thresholds to define chronic kidney disease should not be age dependent. Nephrol Dial Transplant 2014;29:774-9. https://doi.org/10.1093/ndt/gft306.
Blake, GM, Barnfield, MC, Burniston, MT, Cosgriff, PS, Fleming, JS, Murray, AW. Measuring glomerular filtration rate using chromium-51 EDTA: body surface area normalization before or after Brøchner-Mortensen correction? Nucl Med Commun 2015;36:295-300. https://doi.org/10.1097/mnm.0000000000000253.
Grams, ME, Sang, Y, Levey, AS, Matsushita, K, Ballew, S, Chang, AR, et al. Kidney-failure risk projection for the living kidney-donor candidate. N Engl J Med 2016;374:411-21. https://doi.org/10.1056/nejmoa1510491.
Bukabau, JB, Yayo, E, Gnionsahé, A, Monnet, D, Pottel, H, Cavalier, E, et al. Performance of creatinine-or cystatin C-based equations to estimate glomerular filtration rate in sub-Saharan African populations. Kidney Int 2019;95:1181-9. https://doi.org/10.1016/j.kint.2018.11.045.
Kasiske, BL, Anderson-Haag, TL, Duprez, DA, Kalil, RS, Kimmel, PL, Pesavento, TE, et al. A prospective controlled study of metabolic and physiologic effects of kidney donation suggests that donors retain stable kidney function over the first nine years. Kidney Int 2020;98:168-75. https://doi.org/10.1016/j.kint.2020.01.017.
