KIDNEY donation among carefully selected older adults was associated with stable long term kidney function and a low rate of clinically significant decline, according to a study assessing renal outcomes and eGFR measurements over 12 years.
Living kidney donation from older individuals is increasingly considered, but long-term kidney outcomes remain incompletely understood. The impact of different eGFR equations on risk assessment in older donors also remains unclear.
The analysis included 131 living kidney donors aged 60 years or older at the time of donation, with a median follow up of 12 years. Researchers assessed kidney function using three commonly applied eGFR equations at baseline, one year after donation, and during long term follow up.
Across all assessment methods, kidney function demonstrated a similar pattern, with an initial reduction following kidney donation followed by long term stability. Although 37.0% of donors experienced an eGFR decline greater than 40%, chronological age, including age 70 years or older, was not associated with a faster long-term reduction in kidney function.
The findings suggested that biological and cardiometabolic factors were more influential than age alone when evaluating long term kidney donation outcomes.
The study identified several factors associated with a steeper decline in renal function after kidney donation. Reduced renal adaptation at 1 year, baseline hypertension, higher body mass index, and female sex were independently linked with less favourable long term kidney trajectories.
Among donors who maintained preserved kidney function, defined as an eGFR of at least 45 mL/min/1.73 m², albuminuria helped identify a subgroup with potentially less favourable renal outcomes.
The researchers also found that the classification of kidney function varied considerably depending on the eGFR equation applied, particularly at 1 year after donation. These findings highlighted the importance of evaluating kidney function trends over time rather than relying only on single threshold measurements.
Relevant perioperative complications were uncommon, occurring in 2.3% of donors, and no donor required renal replacement therapy during follow up. The findings support the continued consideration of kidney donation among selected older individuals when comprehensive risk assessment is undertaken.
The study concluded that long term monitoring should incorporate individual biological and clinical characteristics alongside appropriate interpretation of eGFR estimates. Further assessment of longitudinal kidney function may help improve risk evaluation and clinical decision making for older living kidney donors.
Reference
Schröter I, Sommerer C. Long-term kidney outcomes after living donation in older adults: clinical findings and equation-dependent eGFR estimates. BMC Geriatr. 2026;26(1):926.
Featured Image: Andrey Bandurenko on Adobe Stock.
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
