GFR Evaluation in Living Kidney Donor Candidates

Evaluation of GFR, required in the evaluation of living kidney donor candidates, is now receiving increasing emphasis because recent data demonstrate increased risk of kidney disease after donation, including a small increase in the risk of kidney failure. The international guideline development group, Kidney Disease Improving Global Outcomes, recently published a comprehensive set of recommendations for living donor evaluation, with three recommendations regarding GFR. (1) Donor candidacy is evaluated in light of long-term risk, in which GFR is one of many factors. ESRD is considered a central outcome, and a method for estimating long-term risk of ESRD in donor candidates is described. (2) Two GFR thresholds are used for decision-making: a high threshold (>= 90 ml/min per 1.73 m(2)) to accept and a low threshold (<60 ml/min per 1.73 m(2)) to decline, with 60-89 ml/min per 1.73 m(2) as an intermediate range in which the decision to accept or decline is made on the basis of factors in addition to GFR. (3) GFR is evaluated using several methods available at the transplant center, including estimating equations and clearance measurements. We review the rationale for the guideline recommendations, principles of GFR measurement and estimation, and our suggestions for implementation.