Pros and cons of live kidney donation in prediabetics: A critical review and way forward

Table 1 Showing association of prediabetes with chronic kidney disease

Ref.	Journal/Year	Study type	Objective	Findings
Fox et al[38]	Diabetes Care/2005	Follow up of Framingham Heart Study (1991-1995) after 75-gram oral glucose tolerance test	To study the impact of IFG and IGT on development of CKD	The odd of developing CKD was 0.98 (95%CI: 0.67-1.45), 1.71 (95%CI: 0.83-3.55) and 1.93 (95%CI: 1.06-3.49) among patients with IFG or IGT, newly diagnosed diabetes or known diabetes
Redon et al[41]	J Am Soc Nephrol/2006	Prospective multicenter, cross-sectional study	To assess the relationship between UAE and glomerular filtration rate in patients with glucose metabolism abnormalities having hypertension	The prevalence of abnormal UAE, > or = 3.4 mg/mmol across the spectrum of glucose abnormalities were 39.7%, 46.2%, 48.6%, and 65.6% for normoglycemic, low-range, and high-range impaired fasting glucose and diabetes. Predictors of low GFR < 60 mL/min were UAE ≥ 3.4 mg/mmol (OR 1.87; 95%CI: 1.61 to 2.17), IFG and diabetes (OR 1.30; 95%CI: 1.05 to 1.62), and BP ≥ 140/90 mmHg, or ≥ 130/80 mmHg if diabetes (OR 1.23; 95%CI: 1.04 to 1.45)
Plantinga et al[40]	Clin J Am Soc Nephrol/2010	Retrospective analysis of 1999-2006 national health and nutrition examination survey	To measure and compare the prevalence of CKD among people with diagnosed diabetes, undiagnosed diabetes, PD, or no diabetes	39.6% of people with diagnosed and 41.7% with undiagnosed diabetes had CKD; 17.7% with PD and 10.6% without diabetes had CKD. Among those with CKD, 39.1% had undiagnosed or PD
Okamoto et al[33]	Transplantation/2010	Retrospective study	To assess the indications for live kidney donation in glucose intolerance and to analyze perioperative complications associated with donor nephrectomies and its long-term consequences	Perioperative complications, survival rates and mortality were not significant between glucose intolerance and those with normal glucose tolerance
Selvin et al[39]	Diabetes/2011	Prospective cohort and cross-sectional analyses of ARIC study	To examine association between 2010 American Diabetes Association diagnostic cut points for glycated hemoglobin and microvascular outcomes (CKD, ESRD and retinopathy)	Risk of CKD, with adjusted HRs of 1.12 (0.94-1.34) and 1.39 (1.04-1.85) was found for glycated hemoglobin 5.7%-6.4% and ≥ 6.5%, respectively, as compared with < 5.7% (P = 0.002). HR for ESRD were 1.51 (0.82-2.76) and 1.98 (0.83-4.73)
Schöttker et al[42]	Prev Med/2013	Prospective study	(1) To determine the risk for incident reduced kidney function in participants with pre-diabetes; and (2) To determine dose-response relationships of fasting glucose and HbA1c with reduced kidney functions in subjects with manifest diabetes mellitus	Reduced kidney function risk factor prevalences and incidences were higher in participants with pre-diabetes than without PD. Increased risk did not persist after adjusting for established cardiovascular risk factors [RR (IFG): 0.97 (95%CI: 0.75-1.25) and RR (HbA1c-defined pre-diabetes): 1.03 (95%CI: 0.86-1.23)]
Chandran et al[14]	Transplantation/2014	Retrospective study	To compare development of diabetes, the estimated glomerular filtration rate, and the level of albumin excretion in donors with IFG to matched controls with normal pre-donation fasting glucose	(1) Higher proportion of IFG donors had developed DM (15.56% vs 2.2%, P = 0.06); (2) eGFR at 10.4 years was 70.7 ± 16.1 vs 67.3 ± 16.6 mL/min/1.73 m2, P = 0.21) was similar between 2 groups; and (3) Urine albumin/creatinine 9.76 ± 23.6 vs 5.91 ± 11 mg/g, P = 0.29) was similar between 2 groups
Echouffo-Tcheugui et al[45]	Diabet Med/2016	Metanalysis	To assess the effect of PD on the incidence of CKD	Relative risk of CKD after adjustment for established risk factors was 1.11 (95%CI: 1.02-1.21) when IFG was defined as 6.1-6.9 mmol/L
Bigotte Vieira et al[43]	J Clin Endocrinol Metab/2019	Post hoc analysis of participants of the SPRINT trial	To find association of PD with adverse kidney outcomes	Impaired fasting glucose was not associated with higher rates of the composite outcome (HR: 0.97; 95%CI: 0.8 to 1.16), worsening kidney function (HR: 1.02; 95%CI: 0.75 to 1.37), or albuminuria (HR: 0.98; 95%CI: 0.78 to 1.23)
Furukawa et al[44]	Diabet Med/2021	Retrospective analysis of health check-up in 2014 in Japan	To investigate the associations of PD with the proteinuria and eGFR decline	PD was independently associated with the proteinuria development (OR 1.233; 95%CI: 1.170-1.301). No association was found with eGFR decline (OR 0.981; 95%CI: 0.947-1.017)
Hebert et al[34]	Transplantation/2022	Retrospective data analysis of The RELIVE study	To study mortality, proteinuria, and ESKD according to donation FPG: < 100 mg/dL, 100-125 mg/dL, and ≥ 1 26 mg/dL	IFG was associated with a higher diabetes risk (adjusted HR, 1.65; 95%CI: 1.18-2.30) and hypertension (adjusted HR 1.35; 95%CI: 1.10-1.65; P = 0.003 for both), but not higher risk of proteinuria or ESKD

PD: Prediabetes; CKD: Chronic kidney disease; IGT: Impaired glucose tolerance; IFG: Impaired fasting glucose; UAE: Urinary albumin excretion; GFR: Glomerular filtration rate; eGFR: Estimated glomerular filtration rate; HR: Hazard ratios; ESRD: End stage renal disease; ARIC: Atherosclerosis risk in communities; OR: Odds ratio; ESKD: End-stage kidney disease; FPG: Fasting plasma glucose; RELIVE: Renal and lung living donors evaluation; BP: Blood press; HbA1c: Glycated hemoglobin; SPRINT: Systolic blood pressure intervention trial; DM: Diabetes mellitus.