Böbrek Nakli Vericilerinde Uzun Süreli Takip Sonucunda Kronik Böbrek Hastalığı Gelişme Riski ve Etkili Faktörler

Abstract

Transplants from living donors constitute a significant part of the kidney transplants performed today. This study aimed to examine the risk of developing chronic kidney diease (CKD) in long-term follow-up of kidney donors, and the related factors. Three hundred and thirty-eight donors were included in the study. The median age of the donors was 47 (39-54 years) and 64.2% of the donors were female. CKD development was observed in 64 (18,9%) donors during the median follow-up of 71 months. Stage 3 CKD has developed in 50 donors and stage 1-2 CKD has developed in 14 donors. None of the donors developed stage 4 or 5 CKD. Older age at the time of transplantation and low glomerular filtration rate (GFR) before the transplantation were found to be the factors affecting the development of stage 3 CKD (p<0.001, p<0.001, respectively). Result of receiver operating characteristic (ROC) analysis showed that the cut-off age for developing stage 3 CKD was 50.5. Both albuminuria and proteinuria values increased after the donor nephrectomy. Albuminuria was observed to be higher in donors with a follow-up longer than 71 months (p=0.012). There was an increase in LDL-cholesterol, triglyceride, glycated hemoglobin and fasting plasma glucose values when pretransplant and the final control values were compared (p=0.011, p <0.001, p<0.001, p=0.001). Newly diagnosed hypertension was detected in 57 (16,8%) patients after the transplantation. Hypertension was observed at a rate of 42% in those with a GFR< 60 ml/min/1.73m2, while it was observed at a rate of 19.4% in the group with a GFR> 60 ml/min/1.73m2 (p<0.001). The donor's 15-year end-stage renal disease (ESRD) risk was calculated based on an online risk calculation tool. It was observed that the 15-year ESRD risk increased in both genders up to the age of 60, and then decreased. Men had a higher risk of ESRD than women. Nine donors died at a median of a 6-years follow-up. The calculated crude mortality rate was found to be 4.4 per thousand. The results show that being a living kidney donor is associated with deterioration in metabolic indicators, hypertension and development of CKD. Age and GFR at the time of transplantation are determinants for the development of CKD.