Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
Department of Nephrology and Hypertension, University Medical Center Utrecht , Utrecht , The Netherlands.
Am J Physiol Renal Physiol. 2018 Sep 1;315(3):F454-F459. doi: 10.1152/ajprenal.00492.2017. Epub 2018 Jan 3.
Maintenance of adequate renal function after living kidney donation is important for donor outcome. Overweight donors, in particular, may have an increased risk for end-stage kidney disease (ESKD), and young female donors have an increased preeclampsia risk. Both of these risks may be associated with low postdonation renal functional reserve (RFR). Because we previously found that higher body mass index (BMI) was associated with lower postdonation RFR, we now studied the relationship between BMI and RFR in young female donors. RFR, the rise in glomerular filtration rate (GFR) (I-iothalamate clearance) during dopamine, was measured in female donors (<45 yr) before and after kidney donation. Donors who are overweight (BMI >25) and nonoverweight donors were compared by Student's t-test; the association was subsequently explored with regression analysis. We included 105 female donors [age 41 (36-44) median(IQR)] with a BMI of 25 (22-27) kg/m. Predonation GFR was 118 (17) ml/min [mean(SD)] rising to 128 (19) ml/min during dopamine; mean RFR was 10 (10) ml/min. Postdonation GFR was 76 (13) ml/min, rising to 80 (12); RFR was 4 (6) ml/min ( P < 0.001 vs. predonation). In overweight donors, RFR was fully lost after donation (1 ml/min vs. 10 ml/min predonation, P < 0.001), and BMI was inversely associated with RFR after donation, independent of confounders (standardized β 0.37, P = 0.02). Reduced RFR might associate with the risk of preeclampsia and ESKD in kidney donors. Prospective studies should explore whether RFR is related to preeclampsia and whether BMI reduction before conception is of benefit to overweight female kidney donors during and after pregnancy.
维持活体肾捐献后充足的肾功能对于供体的预后很重要。超重供体，尤其是可能会增加终末期肾病（ESKD）的风险，而年轻女性供体则有更高的子痫前期风险。这两种风险都可能与低捐献后肾功能储备（RFR）有关。因为我们之前发现较高的体重指数（BMI）与较低的捐献后 RFR 相关，所以现在我们研究了 BMI 与年轻女性供体 RFR 之间的关系。RFR 是多巴胺期间肾小球滤过率（GFR）（I-碘酞酸盐清除率）的升高，在肾捐献前后测量女性供体（<45 岁）的 RFR。通过 Student's t 检验比较超重（BMI>25）和非超重供体；随后用回归分析探讨这种关联。我们纳入了 105 名女性供体[年龄 41（36-44）中位数（IQR）]，BMI 为 25（22-27）kg/m。预捐时的 GFR 为 118（17）ml/min[平均值（SD）]，多巴胺期间升高至 128（19）ml/min；平均 RFR 为 10（10）ml/min。捐后 GFR 为 76（13）ml/min，升高至 80（12）；RFR 为 4（6）ml/min（P<0.001 与预捐时相比）。在超重供体中，RFR 在捐后完全丧失（1ml/min 与预捐时 10ml/min 相比，P<0.001），并且 BMI 与捐后 RFR 呈负相关，独立于混杂因素（标准化β 0.37，P=0.02）。RFR 降低可能与肾供体子痫前期和 ESKD 的风险相关。前瞻性研究应探讨 RFR 是否与子痫前期有关，以及在怀孕前和怀孕期间是否降低 BMI 对超重女性肾供体有益。
