The unjustified classification of kidney donors as patients with CKD: Critique and recommendations

Unilateral nephrectomy for kidney donation results in loss of about 30% of baseline GFR, leaving some donorswith GFR <60 ml/min per 1.73 m², the threshold for the diagnosis CKD. This has resulted in insurability problemsfor some donors. This article reviews the definition of CKD, risks associated with CKD, and large follow-up studieson the vital status and risk of ESRD in kidney donors. It also provides evidence that kidney donors, despite havingreduced GFR, are not at increased risk for CKD-associated morbidity and mortality. Epidemiologic studies, mostwith follow-up <10 years, have shown an association between GFR <60 ml/min per 1.73 m² and higher mortalityand progression to ESRD. Low GFR in the absence of any other markers for kidney disease, however, conveysattenuated or minimal risk. Of note, studies of long-term kidney donor outcomes (6-45 years) have not shownexcess mortality or ESRD. The limitation of the collective evidence is that the increased risks associated with GFR<60 ml/min per 1.73 m² were demonstrated in much larger cohorts than those reported for kidney donor outcomes,but donor outcome studies have substantially longer follow-up. On the basis of current findings, kidneydonors with low GFR and no other signs of kidney disease should not be classified as having CKD. This is definitelynot the reward they deserve, and, more important, the implications of reduced GFR in donors are not associatedwith unfavorable outcomes.