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01-10-2019 | Original Article

Visceral obesity in Asian living kidney donors significantly impacts early renal function after donor nephrectomy

Authors: Gregory Xiang Wen Pek, Clara Lee Ying Ngoh, Boon Wee Teo, Anantharaman Vathsala, Benjamin Yen Seow Goh, Clement Hsiang Rong Yong, Lata Raman, Ho Yee Tiong

Published in: World Journal of Urology | Issue 10/2019

Abstract

Introduction

Obesity may be a risk factor for kidney donors to develop reduced renal function. The Framingham heart study suggested that visceral adipose tissue (VAT) confers a more adverse metabolic profile compared with subcutaneous adipose tissue (SAT). Asians tend to have a higher VAT composition and it is unclear if their kidney function is affected differently. We hypothesized that Asian living kidney donors who have visceral obesity are at a higher risk of renal function deterioration 1 year after donation.

Methods

Between 2011 and 2014, we retrospectively evaluated data from 73 consecutive patients (52% male; mean age 44.9 ± 11.7 years) before they underwent donor nephrectomy and at their 1 year routine follow-up. VAT and SAT were measured at the level of the umbilicus on pre-operative computerized tomography (CT). Visceral obesity (VO) was defined as a VAT > 100 cm [2] and patients were then further divided and compared in two subgroups: VAT > 100 and < 100 cm [2]. Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m [2]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation pre-operatively and 1 year post-operatively.

Results

Both subgroups had similar baseline kidney function (P = NS) pre-operatively. At the 1 year follow-up, patients with VO experienced a more significant decline of renal function (109 ± 9 to 89 ± 8 mL/min per 1.73 m²), compared to those without VO (111 ± 12 to 96 ± 11 mL/min per 1.73 m², P = 0.013). VO was associated with a body mass index (BMI) > 25 kg/m² (P < 0.001), male gender (P < 0.001) and older age at the time of donor nephrectomy (48.0 vs 39.5 years, P = 0.01). The presence of hypertension or hyperlipidaemia pre-operatively, choice of surgical approach, and post-operative complication rates, did not differ significantly between the subgroups.

Conclusions

Visceral obesity as defined by VAT > 100 cm² at the level of the umbilicus on cross-sectional imaging, may have a significant impact on early renal function after donor nephrectomy. Adiposity markers, as measured by cross-sectional CT imaging, may be incorporated into routine pre-operative kidney donor workup.

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Title: Visceral obesity in Asian living kidney donors significantly impacts early renal function after donor nephrectomy
Authors: Gregory Xiang Wen Pek
Clara Lee Ying Ngoh
Boon Wee Teo
Anantharaman Vathsala
Benjamin Yen Seow Goh
Clement Hsiang Rong Yong
Lata Raman
Ho Yee Tiong
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 10/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2566-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Visceral obesity in Asian living kidney donors significantly impacts early renal function after donor nephrectomy

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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