Implications of excess weight on kidney donation

Long-term consequences of donor nephrectomy in obese donors

Oscar K. Serrano, Bodhisatwa Sengupta, Ananta S Bangdiwala, David M Vock, Ty B Dunn, Erik B Finger, Timothy L Pruett, Arthur J Matas, Raja Kandaswamy

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Abstract

Background: An elevated body mass index (>30 kg/m 2 ) has been a relative contraindication for living kidney donation; however, such donors have become more common. Given the association between obesity and development of diabetes, hypertension, and end-stage renal disease, there is concern about the long-term health of obese donors. Methods: Donor and recipient demographics, intraoperative parameters, complications, and short- and long-term outcomes were compared between contemporaneous donors—obese donors (body mass index ≥30 kg/m 2 ) versus nonobese donors (body mass index <30 kg/m 2 ). Results: Between the years 1975 and 2014, we performed 3,752 donor nephrectomies; 656 (17.5%) were obese donors. On univariate analysis, obese donors were more likely to be older (P <.01) and African American (P <.01) and were less likely to be a smoker at the time of donation (P =.01). Estimated glomerular filtration rate at donation was higher in obese donors (115 ± 36 mL/min/1.73m 2 ) versus nonobese donors (97 ± 22 mL/min/1.73m 2 ; P <.001). There was no difference between groups in intraoperative and postoperative complications; but intraoperative time was longer for obese donors (adjusted P <.001). Adjusted postoperative length of stay (LOS) was longer (adjusted P =.01), but after adjustment for donation year, incision type, age, sex, and race, there were no differences in short-term (<30 days) and long-term (>30 days) readmissions. Estimated glomerular filtration rate and rates of end-stage renal disease were not significantly different between donor groups >20 years after donation (P =.71). However, long-term development of diabetes mellitus (adjusted hazard ratio (HR) 3.14; P <.001) and hypertension (adjusted hazard ratio (HR) 1.75; P <.001) was greater among obese donors and both occurred earlier (diabetes mellitus: 12 vs 18 years postnephrectomy; hypertension: 11 vs 15 years). Conclusion: Obese donors develop diabetes mellitus and hypertension more frequently and earlier than nonobese donors after donation, raising concerns about increased rates of end-stage renal disease.

Original languageEnglish (US)
Pages (from-to)1071-1076
Number of pages6
JournalSurgery (United States)
Volume164
Issue number5
DOIs
StatePublished - Nov 1 2018

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Nephrectomy
Tissue Donors
Kidney
Weights and Measures
Chronic Kidney Failure
Hypertension
Diabetes Mellitus
Body Mass Index
Glomerular Filtration Rate
Intraoperative Complications
African Americans
Obesity
Demography

PubMed: MeSH publication types

  • Journal Article

Cite this

@article{67677697524d4104b71624606e29b599,
title = "Implications of excess weight on kidney donation: Long-term consequences of donor nephrectomy in obese donors",
abstract = "Background: An elevated body mass index (>30 kg/m 2 ) has been a relative contraindication for living kidney donation; however, such donors have become more common. Given the association between obesity and development of diabetes, hypertension, and end-stage renal disease, there is concern about the long-term health of obese donors. Methods: Donor and recipient demographics, intraoperative parameters, complications, and short- and long-term outcomes were compared between contemporaneous donors—obese donors (body mass index ≥30 kg/m 2 ) versus nonobese donors (body mass index <30 kg/m 2 ). Results: Between the years 1975 and 2014, we performed 3,752 donor nephrectomies; 656 (17.5{\%}) were obese donors. On univariate analysis, obese donors were more likely to be older (P <.01) and African American (P <.01) and were less likely to be a smoker at the time of donation (P =.01). Estimated glomerular filtration rate at donation was higher in obese donors (115 ± 36 mL/min/1.73m 2 ) versus nonobese donors (97 ± 22 mL/min/1.73m 2 ; P <.001). There was no difference between groups in intraoperative and postoperative complications; but intraoperative time was longer for obese donors (adjusted P <.001). Adjusted postoperative length of stay (LOS) was longer (adjusted P =.01), but after adjustment for donation year, incision type, age, sex, and race, there were no differences in short-term (<30 days) and long-term (>30 days) readmissions. Estimated glomerular filtration rate and rates of end-stage renal disease were not significantly different between donor groups >20 years after donation (P =.71). However, long-term development of diabetes mellitus (adjusted hazard ratio (HR) 3.14; P <.001) and hypertension (adjusted hazard ratio (HR) 1.75; P <.001) was greater among obese donors and both occurred earlier (diabetes mellitus: 12 vs 18 years postnephrectomy; hypertension: 11 vs 15 years). Conclusion: Obese donors develop diabetes mellitus and hypertension more frequently and earlier than nonobese donors after donation, raising concerns about increased rates of end-stage renal disease.",
author = "Serrano, {Oscar K.} and Bodhisatwa Sengupta and Bangdiwala, {Ananta S} and Vock, {David M} and Dunn, {Ty B} and Finger, {Erik B} and Pruett, {Timothy L} and Matas, {Arthur J} and Raja Kandaswamy",
year = "2018",
month = "11",
day = "1",
doi = "10.1016/j.surg.2018.07.015",
language = "English (US)",
volume = "164",
pages = "1071--1076",
journal = "Surgery",
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TY - JOUR

T1 - Implications of excess weight on kidney donation

T2 - Long-term consequences of donor nephrectomy in obese donors

AU - Serrano, Oscar K.

AU - Sengupta, Bodhisatwa

AU - Bangdiwala, Ananta S

AU - Vock, David M

AU - Dunn, Ty B

AU - Finger, Erik B

AU - Pruett, Timothy L

AU - Matas, Arthur J

AU - Kandaswamy, Raja

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: An elevated body mass index (>30 kg/m 2 ) has been a relative contraindication for living kidney donation; however, such donors have become more common. Given the association between obesity and development of diabetes, hypertension, and end-stage renal disease, there is concern about the long-term health of obese donors. Methods: Donor and recipient demographics, intraoperative parameters, complications, and short- and long-term outcomes were compared between contemporaneous donors—obese donors (body mass index ≥30 kg/m 2 ) versus nonobese donors (body mass index <30 kg/m 2 ). Results: Between the years 1975 and 2014, we performed 3,752 donor nephrectomies; 656 (17.5%) were obese donors. On univariate analysis, obese donors were more likely to be older (P <.01) and African American (P <.01) and were less likely to be a smoker at the time of donation (P =.01). Estimated glomerular filtration rate at donation was higher in obese donors (115 ± 36 mL/min/1.73m 2 ) versus nonobese donors (97 ± 22 mL/min/1.73m 2 ; P <.001). There was no difference between groups in intraoperative and postoperative complications; but intraoperative time was longer for obese donors (adjusted P <.001). Adjusted postoperative length of stay (LOS) was longer (adjusted P =.01), but after adjustment for donation year, incision type, age, sex, and race, there were no differences in short-term (<30 days) and long-term (>30 days) readmissions. Estimated glomerular filtration rate and rates of end-stage renal disease were not significantly different between donor groups >20 years after donation (P =.71). However, long-term development of diabetes mellitus (adjusted hazard ratio (HR) 3.14; P <.001) and hypertension (adjusted hazard ratio (HR) 1.75; P <.001) was greater among obese donors and both occurred earlier (diabetes mellitus: 12 vs 18 years postnephrectomy; hypertension: 11 vs 15 years). Conclusion: Obese donors develop diabetes mellitus and hypertension more frequently and earlier than nonobese donors after donation, raising concerns about increased rates of end-stage renal disease.

AB - Background: An elevated body mass index (>30 kg/m 2 ) has been a relative contraindication for living kidney donation; however, such donors have become more common. Given the association between obesity and development of diabetes, hypertension, and end-stage renal disease, there is concern about the long-term health of obese donors. Methods: Donor and recipient demographics, intraoperative parameters, complications, and short- and long-term outcomes were compared between contemporaneous donors—obese donors (body mass index ≥30 kg/m 2 ) versus nonobese donors (body mass index <30 kg/m 2 ). Results: Between the years 1975 and 2014, we performed 3,752 donor nephrectomies; 656 (17.5%) were obese donors. On univariate analysis, obese donors were more likely to be older (P <.01) and African American (P <.01) and were less likely to be a smoker at the time of donation (P =.01). Estimated glomerular filtration rate at donation was higher in obese donors (115 ± 36 mL/min/1.73m 2 ) versus nonobese donors (97 ± 22 mL/min/1.73m 2 ; P <.001). There was no difference between groups in intraoperative and postoperative complications; but intraoperative time was longer for obese donors (adjusted P <.001). Adjusted postoperative length of stay (LOS) was longer (adjusted P =.01), but after adjustment for donation year, incision type, age, sex, and race, there were no differences in short-term (<30 days) and long-term (>30 days) readmissions. Estimated glomerular filtration rate and rates of end-stage renal disease were not significantly different between donor groups >20 years after donation (P =.71). However, long-term development of diabetes mellitus (adjusted hazard ratio (HR) 3.14; P <.001) and hypertension (adjusted hazard ratio (HR) 1.75; P <.001) was greater among obese donors and both occurred earlier (diabetes mellitus: 12 vs 18 years postnephrectomy; hypertension: 11 vs 15 years). Conclusion: Obese donors develop diabetes mellitus and hypertension more frequently and earlier than nonobese donors after donation, raising concerns about increased rates of end-stage renal disease.

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U2 - 10.1016/j.surg.2018.07.015

DO - 10.1016/j.surg.2018.07.015

M3 - Article

VL - 164

SP - 1071

EP - 1076

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 5

ER -