Key result
Living kidney donation increases aortic stiffness by ~0.4 m/s at 1 year versus controls.
Why the study?
Increased aortic stiffness is associated with adverse cardiovascular outcomes, and some studies have reported increased cf-PWV in living kidney donors after nephrectomy.
Does nephrectomy for living kidney donation increase aortic stiffness in healthy adults compared to non-nephrectomised individuals?
Meta-Analysis (n=7,532)
Does nephrectomy for living kidney donation increase aortic stiffness in healthy adults compared to non-nephrectomised individuals?
Mean Difference: 0.4 (95% CI 0.07–0.6)
p-value: p=0.01
Living kidney donation is associated with a transient increase in aortic stiffness at 1 year that resolves by 5 years, suggesting minimal long-term adverse cardiovascular remodeling despite sustained reductions in kidney function.
May warrant short-term aortic stiffness monitoring in donors; leaves open long-term CV risk beyond 5 years despite GFR decline.
OBJECTIVES: Increased aortic stiffness measured with carotid-femoral pulse wave velocity (cf-PWV) has been associated with adverse cardiovascular outcomes. Some studies have reported increased cf-PWV in living kidney donors after nephrectomy. This review aimed to determine the effects of living kidney donation on cf-PWV, glomerular filtration rate (GFR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and their differences versus non-nephrectomised healthy individuals. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Electronic databases (MEDLINE, EMBASE, Cochrane Central databases, Cochrane Register of Controlled Trials, Cochrane Methodology Register, Health Technology Database, Technologies in Health, EBM Reviews, ProQuest and 'Grey Matters Light'). Databases were searched from inception to December 2022. ELIGIBILITY CRITERIA: We searched for studies that measured cf-PWV in living kidney donors before and/or after nephrectomy. Non-nephrectomised healthy individuals included as controls were the comparators. Studies that provided age-adjusted cf-PWV reference values in normotensive healthy individuals were also included. OUTCOME MEASURES: We evaluated the mean differences in cf-PWV, GFR and BP before-and-after nephrectomy and their mean differences versus non-nephrectomised healthy comparators. We also explored differences in yearly adjusted cf-PWV changes between donors and normotensive healthy individuals. DATA EXTRACTION/SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias (Risk of Bias tool for non-Randomised studies: ROBINS-I) and quality of evidence (GRADE). Pooled effect estimates were calculated using the inverse variance method and analysed with random effect models. RESULTS: Nine interventional (652 donors; 602 controls) and 6 reference studies (6278 individuals) were included. cf-PWV increased at 1-year postdonation (p=0.03) and was on average 0.4 m/s (95% CI 0.07; 0.60) higher than in healthy controls (p=0.01). These differences were non-significant 5 years postnephrectomy (p=0.54). GFR decreased after nephrectomy (p<0.001) and remained reduced compared with healthy controls (p<0.001), but SBP and DBP were not significantly different (p≥0.14). Yearly changes in cf-PWV postnephrectomy were similar to age-adjusted reference values in healthy normotensive individuals (p=0.76). CONCLUSIONS: Aortic stiffness increases independent of BP 1 year after kidney donation, but the long-term effects seem minimal. These findings may impact future consent of prospective living kidney donors. PROSPERO REGISTRATION NUMBER: CRD42020185551.
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Rodriguez et al. (2024) conducted a meta-analysis in Living kidney donation (n=7,532). Nephrectomy for kidney donation vs. Non-nephrectomised healthy individuals was evaluated on Mean difference in carotid-femoral pulse wave velocity (cf-PWV) at 1-year postdonation compared with healthy controls (MD 0.4 m/s, 95% CI 0.07-0.60, p=0.01). Nephrectomy for living kidney donation increased aortic stiffness by a mean difference of 0.4 m/s at 1 year compared to healthy controls, but these differences became non-significant at 5 years.
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