Aortic stiffness after living kidney donation: a systematic review and meta-analysis
Objectives Increased aortic stiffness measured with carotid-femoral pulse wave velocity (cf-PWV) has been associated with adverse cardiovascular outcomes. Some studies have reported increased cf-PWV in living kidney donors after nephrectomy. This review aimed to determine the effects of living kidne...
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/12/e082725.full |
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| author | Kevin D Burns Rosendo A Rodriguez Mohsen Agharazii Ann Bugeja Edward G Clark Kylie McNeill |
| author_facet | Kevin D Burns Rosendo A Rodriguez Mohsen Agharazii Ann Bugeja Edward G Clark Kylie McNeill |
| author_sort | Kevin D Burns |
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| description | Objectives Increased aortic stiffness measured with carotid-femoral pulse wave velocity (cf-PWV) has been associated with adverse cardiovascular outcomes. Some studies have reported increased cf-PWV in living kidney donors after nephrectomy. This review aimed to determine the effects of living kidney donation on cf-PWV, glomerular filtration rate (GFR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and their differences versus non-nephrectomised healthy individuals.Design Systematic review and meta-analysis.Data sources Electronic databases (MEDLINE, EMBASE, Cochrane Central databases, Cochrane Register of Controlled Trials, Cochrane Methodology Register, Health Technology Database, Technologies in Health, EBM Reviews, ProQuest and ‘Grey Matters Light’). Databases were searched from inception to December 2022.Eligibility criteria We searched for studies that measured cf-PWV in living kidney donors before and/or after nephrectomy. Non-nephrectomised healthy individuals included as controls were the comparators. Studies that provided age-adjusted cf-PWV reference values in normotensive healthy individuals were also included.Outcome measures We evaluated the mean differences in cf-PWV, GFR and BP before-and-after nephrectomy and their mean differences versus non-nephrectomised healthy comparators. We also explored differences in yearly adjusted cf-PWV changes between donors and normotensive healthy individuals.Data extraction/synthesis Two independent reviewers extracted data and assessed risk of bias (Risk of Bias tool for non-Randomised studies: ROBINS-I) and quality of evidence (GRADE). Pooled effect estimates were calculated using the inverse variance method and analysed with random effect models.Results Nine interventional (652 donors; 602 controls) and 6 reference studies (6278 individuals) were included. cf-PWV increased at 1-year postdonation (p=0.03) and was on average 0.4 m/s (95% CI 0.07; 0.60) higher than in healthy controls (p=0.01). These differences were non-significant 5 years postnephrectomy (p=0.54). GFR decreased after nephrectomy (p<0.001) and remained reduced compared with healthy controls (p<0.001), but SBP and DBP were not significantly different (p≥0.14). Yearly changes in cf-PWV postnephrectomy were similar to age-adjusted reference values in healthy normotensive individuals (p=0.76).Conclusions Aortic stiffness increases independent of BP 1 year after kidney donation, but the long-term effects seem minimal. These findings may impact future consent of prospective living kidney donors.PROSPERO registration number CRD42020185551. |
| format | Article |
| id | doaj-art-5ed03601fe6b4ea2a55c0bfa4b0aa80f |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-12-01 |
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| spelling | doaj-art-5ed03601fe6b4ea2a55c0bfa4b0aa80f2024-12-17T01:30:09ZengBMJ Publishing GroupBMJ Open2044-60552024-12-01141210.1136/bmjopen-2023-082725Aortic stiffness after living kidney donation: a systematic review and meta-analysisKevin D Burns0Rosendo A Rodriguez1Mohsen Agharazii2Ann Bugeja3Edward G Clark4Kylie McNeill51 Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada1 Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada2 Division of Nephrology, CHU de Québec-Université Laval, Québec City, Québec, Canada1 Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada1 Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada1 Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, CanadaObjectives Increased aortic stiffness measured with carotid-femoral pulse wave velocity (cf-PWV) has been associated with adverse cardiovascular outcomes. Some studies have reported increased cf-PWV in living kidney donors after nephrectomy. This review aimed to determine the effects of living kidney donation on cf-PWV, glomerular filtration rate (GFR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and their differences versus non-nephrectomised healthy individuals.Design Systematic review and meta-analysis.Data sources Electronic databases (MEDLINE, EMBASE, Cochrane Central databases, Cochrane Register of Controlled Trials, Cochrane Methodology Register, Health Technology Database, Technologies in Health, EBM Reviews, ProQuest and ‘Grey Matters Light’). Databases were searched from inception to December 2022.Eligibility criteria We searched for studies that measured cf-PWV in living kidney donors before and/or after nephrectomy. Non-nephrectomised healthy individuals included as controls were the comparators. Studies that provided age-adjusted cf-PWV reference values in normotensive healthy individuals were also included.Outcome measures We evaluated the mean differences in cf-PWV, GFR and BP before-and-after nephrectomy and their mean differences versus non-nephrectomised healthy comparators. We also explored differences in yearly adjusted cf-PWV changes between donors and normotensive healthy individuals.Data extraction/synthesis Two independent reviewers extracted data and assessed risk of bias (Risk of Bias tool for non-Randomised studies: ROBINS-I) and quality of evidence (GRADE). Pooled effect estimates were calculated using the inverse variance method and analysed with random effect models.Results Nine interventional (652 donors; 602 controls) and 6 reference studies (6278 individuals) were included. cf-PWV increased at 1-year postdonation (p=0.03) and was on average 0.4 m/s (95% CI 0.07; 0.60) higher than in healthy controls (p=0.01). These differences were non-significant 5 years postnephrectomy (p=0.54). GFR decreased after nephrectomy (p<0.001) and remained reduced compared with healthy controls (p<0.001), but SBP and DBP were not significantly different (p≥0.14). Yearly changes in cf-PWV postnephrectomy were similar to age-adjusted reference values in healthy normotensive individuals (p=0.76).Conclusions Aortic stiffness increases independent of BP 1 year after kidney donation, but the long-term effects seem minimal. These findings may impact future consent of prospective living kidney donors.PROSPERO registration number CRD42020185551.https://bmjopen.bmj.com/content/14/12/e082725.full |
| spellingShingle | Kevin D Burns Rosendo A Rodriguez Mohsen Agharazii Ann Bugeja Edward G Clark Kylie McNeill Aortic stiffness after living kidney donation: a systematic review and meta-analysis BMJ Open |
| title | Aortic stiffness after living kidney donation: a systematic review and meta-analysis |
| title_full | Aortic stiffness after living kidney donation: a systematic review and meta-analysis |
| title_fullStr | Aortic stiffness after living kidney donation: a systematic review and meta-analysis |
| title_full_unstemmed | Aortic stiffness after living kidney donation: a systematic review and meta-analysis |
| title_short | Aortic stiffness after living kidney donation: a systematic review and meta-analysis |
| title_sort | aortic stiffness after living kidney donation a systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/14/12/e082725.full |
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