#2665 Acute kidney injury (AKI) and chronic kidney disease (CKD) in living kidney donors (LKD): time for a new “surgical” classification system?

Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) represent two significant complications in patients who undergo radical (RN) nephrectomy in oncological patients. However, Living kidney donors (LKD) undergo a similar surgery, but kidney dysfunctions are rare. Our study aimed to investigate the incidence of AKI and CKD in a consecutive cohort of LKD.

This multi-institutional study involved 256 kidney donors who performed RN between 2014 and 2021 in four tertiary care hospitals. Clinical and laboratory data were collected at baseline pre-surgery, six months after surgery, and then every 12 months for a five-year follow-up. eGFR was calculated with the CKD-EPI equation. Statistical analysis was performed using descriptive statistics and logistic regression.

Descriptive analysis is reported in Table 1. Of note, the rate of AKI was high (85%), even though it was 100% of stage 1. At 12 months, LKD missed 27.9 ± 19.67 ml/min/1.73 m², persisting stable at 60 months. 26% of patients developed CKD stage GIII, and 10% of patients lost about 30 ml/min/1.73 m² from the baseline eGFR (Fig. 1 and Tables 1 and 2). The multivariate analysis (logistic regression) showed that age had a direct correlation with the risk of AKI (OR 1.057, p = 0.019), while the female sex was inversely correlated (OR 0.180, p = 0.006); on the other hand, age had a direct correlation with the risk of CKD (OR 1.15, p = 0.001), as well as eGFR before the surgery (OR 1,053, p = 0.027).

AKI and CKD affected a non-negligible percentage of LKD. However, it is remarkable that most LKD had a medium final eGFR >60 ml/min/1.73 m² due to a healthy solitary kidney that worked properly, increasing its function by about 30% of its baseline capacity.

Figure 1:

Renal decay in acute and chronic scenarios in LKD.

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