Hypertension and obesity in living kidney donors

Table 1 Summary of studies addressing outcome of hypertensive and obese living kidney donors post-donation

Ref.	Donors (n)	Follow up period	Obesity pre-donation	Hypertension pre-donation
Thukral et al[7]	65	5 yr	26% had BMI > 25 at the time of donation. Significant increase in BMI and drop in eGFR at 5-year follow up. 22.3% later developed DM as well	49.3% with no h/o prior HTN. Significant increase in mean SBP, DBP and number of HTN medications in patients with prior HTN at 5-yr follow-up
Tavakol et al[15]	98	Donors from 1967-2003 compared to two-kidney controls 2005-2006	16 obese donors (BMI > 30) with none having DM at the time of donation. No significant difference in decrease in GFR in obese vs non-obese groups. Obese patients had more proteinuria and albuminuria on multivariate analysis	No patient had HTN at donation. Significantly, more obese patients developed HTN
Serrano et al[17]	3752	10-40 yr	652 obese donors (17%, BMI > 30). Intra operative time longer in obese. No significant difference in short- (< 30 d) and long- (> 30 d) term readmission. No difference in GFR and ESRD development in obese patients	Significant difference in long term development of DM and HTN in obese patients
Rea et al[14]	49	340 d	49 obese donors (mean BMI 37.6 ± 5.0) vs 41 non-obese donors (mean BMI 24.8 ± 2.2). No significant difference in pre-and post-donation serum creatinine and micro-albuminuria
Kerkeni et al[16]	189	9.28 yr	No significant increase in post-operative complications. High BMI patients (mean BMI 26.8) maintained normal renal functions and didn’t developed proteinuria as compared to lower BMI patient (mean BMI 25.2 kg/m2) and this difference was not significant
Lafranca et al[18]	14 studies, 1192 donors	Systematic review	Operation duration and conversion rate from Laproscopic to open procedure was significantly higher in high BMI group (BMI > 30). No significant difference in decrease in eGFR, peri-operative complication rates
Praga et al[27]	73	> 12 mo (13.6 ± 8.6 yr)	Significant difference in development of renal insufficiency and proteinuria in obese patients (BMI > 30) as compared to non-obese patient even after multiple regression analysis
Nogueira et al[28]	39	7.1 ± 1.6 yr	Significant difference in decrease in eGFR from baseline in obese patients (BMI > 35 kg/m2)
Ozdemir et al[37]	2265	15 yr		6.21-fold high risk of ESRD in 15 yr in patients with pre-donation HTN controlled on medications
Quadri et al[44]	129689	5 yr	Among those with age < 50 yr, pre-existing HTN + obesity (BMI > 30 kg/m2) were associated with a 24-fold increased risk of no eGFR compensation of the remaining kidney over 5 yr post-donation

BMI: Body mass index; eGFR: Estimated glomerular filtration rate; HTN: Hypertension; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; DM: Diabetes mellitus; ESRD: End-stage renal disease.