A meta-analysis of renal outcomes in living kidney donors.
Li S, Huang Y, et al.Medicine 2016; 95(24): e3847.
Aims
To conduct a systematic review and meta-analysis to investigate the short, mid, and long-term changes in renal function relative to proteinuria/albuminuria, end-stage renal disease (ESRD), and mortality in living kidney donors.
Interventions
Five English databases including PubMed, ProQuest, Cochrane Library, MEDLINE, and EMBASE were searched along with four Chinese and Japanese databases and the United Network for Organ Sharing and Organ Procurement and Transplantation Network from 1973 to 2014. Included articles were published in either English or Chinese and included original interventions comparing renal outcomes before and after donation or between donors and non-donors.
Participants
62 studies published from 19 countries involving a total of 114,783 participants were included in this meta-analysis.
Outcomes
The primary measured outcomes included rates of mortality, ESRD, and proteinuria/albuminuria. The secondary outcomes measured were the remnant kidney function parameters such as glomerular filtration rate, creatinine clearance rate, and serum creatinine.
Follow-up
Up to 27 years
CET Conclusions
This systematic review was well conducted, searched sufficient databases, and included 62 studies (114,783) patients. There was an enormous degree of statistical heterogeneity between the studies and the authors have explained this as an artefact of the age at which patients donated, age being the best predictor of mortality. Risk of bias, as assessed by the RoBANS tool suggested low risk of bias for the majority of studies across most domains. GFR after donation dropped by 9.7-19.9 ml/min (95%CI) although the drop is worst in the first 6 months after donation and comes back up to near normal after 5 years (-6.1ml/min, 95%CI: -23.8 to 11.5 ml/min). This is an interesting study of an interesting topic and unfortunately there is not much discussion in this report, so the reader is left feeling that an opportunity has been missed.
Quality notes
Quality assessment not appropriate
Trial registration
None