Kidney Week

Abstract: SA-PO971

Postdonation Weight Gain Is Associated with Lower Likelihood of Recovering Predonation eGFR

Session Information

• Transplantation: Clinical - 3
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Reed, Rhiannon D., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Rhiannon D. Reed, DrPH

• Mcleod, Marshall Chandler, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Marshall Chandler Mcleod, MS, PhD

• Maclennan, Paul A., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Paul A. Maclennan, PhD, MPH

• Kumar, Vineeta, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Vineeta Kumar, MD, FASN

• Locke, Jayme E., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Jayme E. Locke, MD, MPH

Background

Living kidney donors with obesity (body mass index (BMI) ≥ 30 kg/m²) at donation have a lower likelihood of recovery of estimated glomerular filtration rate (eGFR) post-donation. We sought to understand whether early post-donation changes in weight are also associated with the likelihood of eGFR recovery.

Methods

Using data from the Scientific Registry of Transplant Recipients, we examined 91,653 adult living kidney donors (1999-2023) with pre-operative serum creatinine and height/weight measurements and at least one creatinine and weight measurement post-donation. We utilized the 2021 CKD-EPI equation to estimate eGFR, and Cox proportional hazards regression with a time-varying covariate for change in BMI was utilized to estimate the likelihood of recovering at least 60% of pre-donation eGFR, censoring for last creatinine measurement.

Results

Among a cohort that was majority female (63%) and white (85%), donors were median age 43 years (IQR: 33-52) and median BMI 26.6 kg/m² (IQR: 24.0-29.6). Median pre-donation serum creatinine was 0.80 mg/dL (IQR: 0.70-0.93), with a median mean arterial pressure of 90 mmHg (IQR: 83.3-96.3). On unadjusted analyses, gaining > 5% BMI (a clinically relevant threshold for risk of cardiovascular and obesity-related complications) was associated with a 7% lower likelihood of recovering 60% of pre-donation eGFR (HR: 0.93, 95% CI: 0.92-0.94, p< 0.001), while losing > 5% BMI was positively associated with recovery (HR: 1.02, 95% CI: 1.00-1.03, p=0.01). After adjusting for relevant baseline factors, gaining > 5% BMI remained significantly associated with a lower likelihood of eGFR recovery (aHR: 0.91, 95% CI: 0.90-0.93, p < 0.001) (Figure).

Conclusion

Weight change in the early post-donation period is a modifiable factor that is associated with recovery of kidney function. These findings highlight the need for a greater commitment to support living donors in maintaining healthy lifestyles post-donation and prospective studies of living donor follow-up.

Funding

• NIDDK Support