The eGFR threshold is different according to age and gender. the BTS guideline summarized in Table 5.5.1
with advancement in age, the lowest threshold is 70 in males and 63 for females (for age 80 as an example). This is 90 (male) and 87 (female) for the age of 50.
CARLOS TADEU LEONIDIO
2 years ago
It is important to recognize the limitations of the current evidence base, as the answer to this question is based on a series of reports with long-term post-donation results comprising mainly Caucasians, normotensive, non-diabetic and normoalbuminuric donors, with a mean age of 45 years, population that is not the majority of donations nowadays.
In this population, the lowest threshold for donation was a GFR >80 mL/min/1.73m2.
Rehab Fahmy
2 years ago
GFR >80 ml/min for pt age 40 years old
and according to age group
with no albuminuria ,no hematuria
Mohamed Ghanem
2 years ago
A safe threshold of kidney function before to donation is one that leaves enough function after donation to keep the donor in normal health (or minimum absolute decline of health) without impacting longevity.
The majority of series documenting long-term post-donation outcomes mostly include:
normotensive,
non-diabetic, and normoalbuminuric
Caucasian donors.
The lower BTS/RA Living Donor Kidney Transplantation Guidelines criteria for donation is a GFR >80 mL/min/1.73m2, and the cohorts’ median age at donation has been about 45 years.
We must asses before kidney donation 3 items :
Early kidney function upon donation, following compensation for the remaining kidney
lifetime rate of kidney function loss following donation
Risk of ESKD in this donor
Ref :
BTS
ahmed saleeh
2 years ago
A safe threshold level of pre-donation kidney function is one that leaves sufficient function after donation to maintain the donor in normal health (or minimal absolute reduction of health) without affecting lifespan.
Amna Khalifa
2 years ago
When the GFR is less than 60 mL/min/1.73 m2, regardless of age, the KDIGO guidelines prohibit donation.
A GFR of 60 mL/min/1.73 m2 appears to be an absolute no-no for donation. A GFR greater than 90 mL/min/1.73 m2 is never considered incompatible with donation, even for the youngest candidates. (2017) (KL Lentine et al.).
The age and gender-specific GFR based on almost 3000 Healthy Potential UK living kidney donors
Threshold GFR (mL/min/1.73m2 )
Age (years) Male Female
20-29 90 90
30-34 80 80
35 80 80
40 80 80
45 80 80
50 80 80
55 80 80
60 76 70
70 67 59
75 63 54
80 58 4
References:
-KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors August 2017 . Volume 101 . Number 8S-1.
-BTS/RA Living Donor Kidney Transplantation Guidelines 2018
Rahul Yadav rahulyadavdr@gmail.com
2 years ago
As per the British society guidelines 2017, attached safe threshold of kidney function for donation.
A threshold of GFR above 80 ml/min/m2 at age of 45, appears acceptable.
Hinda Hassan
2 years ago
Pre-donation mGFR should be such that the predicted post-donation GFR remains within the gender and age-specific normal range within the donor’s lifetime.
BTS/RA Living Donor Kidney Transplantation Guidelines 2018
Alyaa Ali
2 years ago
According to BTS/RA living donor kidney transplantation guidelines
The age and gender -specific GFRs are considered safe to donate
A threshold of GFR more than 80 mi/min/1.73 m2 appears safe for donation in the age 35 years.
According to KDIGO guidelines : donor candidates with GFR more than 90 mi/min/1.73 m2 should be considered acceptable, and those with GFR less than 60 mi/min/1.73 m2 should be excluded , the decision about donors with GFR between them should be individualized according to donor health.
Ramy Elshahat
2 years ago
What is a safe threshold level of kidney function to donate?with aging kidneys like any organ are exposed to aging in the form of glomerulosclerosis which can be estimated by this equation ([age/2]−10) which is usually used by pathologists.
each age group there is accepted GFR which consider normal and safe to be accepted as a potential donor. also accepted GFR differs from male to female because of different muscle bulk.
the following diagram accepted kidney function based on both age and sex References : British Transplantation Society http://www.bts.org.uk March 2018 The Evaluation of Kidney Function in Living Kidney Donor Candidates.
Jamila Elamouri
2 years ago
What is a safe threshold level of kidney function to donate?
A safe threshold level of pre-donation kidney function is the one that keep sufficient kidney function after donation to ensure normal health to the donor, without affecting lifespan. For this we need to define normal kidney function and the normal range of changes in kidney function related to age over time.
A threshold GFR >80 mL/min/1.73m2 appears safe for donation in the 35 year and above age range.
A threshold for donation of >90 mL/min/1.73m2 has therefore been set for those <30 years.
Age (years) Threshold GFR (mL/min/1.73m2)
Male Female 20 – 29 90 90
30 – 50 80 80
55 80 75
60 76 70
65 71 64
70 67 59
75 63 54
80 49 49
Reference BTG
Hamdy Hegazy
2 years ago
4. What is a safe threshold level of kidney function to donate? According to 2017 KDIGO guidelines recommend GFR 90 ml/min/m2 or higher is considered an acceptable level for donation. GFR lower than 60 ml/min/m2 is not accepted. Age & gender specific GFR for potential UK living kidney donors: Age (20-29y) ——à 90 ml/min/m2 for male and female donors. Age (30-55y) ——à 80 ml/min/m2 for male and female donors. Age (56-60y) —–à 76 ml/min/m2 for male donors, and 70 ml/min/m2 for female donors. Age (61-70y) —–à67 ml/min/m2 for male donors, and 59 ml/min/m2 for female donors. Age (71-75y) —–à63 ml/min/m2 for male donors, and 54 ml/min/m2 for female donors. Age (76-80y) —-à 58 ml/min/m2 for male donors and 54 ml/min/m2 for female donors.
Ahmed Fouad Omar
2 years ago
KDIGO guidelines 2017 states that a GFR of 90 mL/min per 1.73 m2 or greater should be considered as acceptable for donation. If eGFR< 60 ml/min, donation is not allowed. Donors with levels between 60 and 89 ml/min are assessed on individual basis by assessing the risk of renal impairment versus program’s pre-established risk threshold, if the post donation risk is higher than the program’s acceptable threshold, the donor is declined.
In the BTS guide lines , 2018 ,the safe threshold is the pre-donation renal function that maintain the donor in a normal health without affecting the life span, and keep the donor with normal age related kidney function after donation.
· The age and gender-specific GFR based on almost 3000 Healthy Potential UK living kidney donors
Threshold GFR (mL/min/1.73m2 )
Age (years) Male Female
20-29 90 90
30-34 80 80
35 80 80
40 80 80
45 80 80
50 80 80
55 80 80
60 76 70
70 67 59
75 63 54
80 58 4
References:
-KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors August 2017 . Volume 101 . Number 8S-1.
-BTS/RA Living Donor Kidney Transplantation Guidelines 2018
Nasrin Esfandiar
2 years ago
According to BTS guidelines, people below 30 years of age who have a GFR above 90 ml/min and people older than 30 having a GFR more than 80 ml/min can donate. However, for people over 50 years of age, this number is reduced to 75, 70, 64, 59, 54 and 49 for females at 55, 60,65,70,75 and 80 years old. This safe threshold refers to no risk for having a normal life without kidney failure.
Nazik Mahmoud
2 years ago
According to BTS guidelines eGFR between 90-60 ml/min/1.7m
Ahmed Abd El Razek
2 years ago
The safest threshold for donation eGFR should be exceeding 90 ml /min /m2 in general population, with the advancement of age, older donors can be considered for donation according their age related standard for eGFR as they are less likely to develop renal disease after their old age with meticulous selection.
According to the American society of transplantation.
2016 Jan;16(1):171-80.
doi: 10.1111/ajt.13540.
Balaji Kirushnan
2 years ago
Renal transplantation evaluation require careful selection of the donor as the life time risk of ESRD in donors is always a concern especially after the Norwegian study and the JAMA 2014 publication which prove that donors have a life risk of ESRD as compared to non donors…But however the absolute risk of ESRD is low and careful selection of the donors can mitigate the risk of ESRD in the donors….
The safe threshold for GFR donation is different according to various guidelines
The KDIGO guidelines in 2017 state that GFR >90ml/min/m2 is needed for safe threshold for kidney donation….GFR < 60ml/min/m2 is contraindicated for kidney donation….The GFR between 60 – 90 ml/min/m2 they recommend a risk assessment and individualized approach for kidney donation recommendation…
The British Transplantation Society guidelines in 2018 recommend age related cut off for GFR donation….In general GFR>80ml/min/m2 for an average age of 35 years is recommended…they have incorporated age related GFR decline that is 6.6ml/min/m2 in males and 7.7 ml/min/m2 in females every decade after the age of 40 years and recommend GFR threshold for every age group….If the age group is less than 35 years they recommend GFR of >90 ml/min/m2 as they have life longevity which exposes them to various lifestyle diseases and autoimmune conditions…..At the age of 80 years the acceptable threshold for GFR as 58 and 49 ml/minm2. The BTS guidelines recommend that the post donation GFR should be sufficient enough to provide normal renal functions later in life…
Tahani Ashmaig
2 years ago
Potential donors between 18 and 30 years old should have a GFR ≥ 90 ml/min/1.73 m2 to be accepted, a GFR ≥ 85 ml/min/1.73 m2 for donors between 31 and 40 years old, a GFR ≥ 80 ml/min/1.73 m2 for those 41 to 65 years old, and a GFR ≥ 75 ml/min/1.73 m2 for those >65 years old
Esraa Mohammed
2 years ago
KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors CHAPTER 5: PREDONATION KIDNEY FUNCTIONEvaluation
5.1: Donor kidney function should be expressed as glomerular filtration rate (GFR) and not as serum creatinine concentration.
5.2: Donor GFR should be expressed in mL/min per 1.73 m2 rather than mL/min.
5.3: Donor glomerular filtration rate (GFR) should be estimated from serum creatinine (eGFRcr) for initial assessment, following recommendations from the KDIGO 2012 CKD guideline.
5.4: Donor GFR should be confirmed using one or more of the following measurements, depending on availability:
Measured GFR (mGFR) using an exogenous filtration marker, preferably urinary or plasma clearance of inulin, urinary or plasma clearance of iothalamate, urinary or plasma clearance of 51Cr-EDTA, urinary or plasma clearance of iohexol, or urinary clearance of 99mTc-DTPA
Measured creatinine clearance (mCrCl)
Estimated GFR from the combination of serum creatinine and cystatin C (eGFRcr-cys) following recommendations from the KDIGO 2012 CKD guideline
Repeat estimated GFR from serum creatinine (eGFRcr)
5.5: If there are parenchymal, vascular or urological abnormalities or asymmetry of kidney size on renal imaging, single kidney GFR should be assessed using radionuclides or contrast agents that are excreted by glomerular filtration (eg, 99mTc-DTPA).
Wee Leng Gan
2 years ago
British Transplantation Society-BTS 2018
Rule out potential donors with CKD (eGFR < 45 ml/min/1.73 m2).
GFR > 45 ml/min/1.73 m2, should be confirmed by mGFR with inulin clearance, 51Cr-EDTA, 125I-iothalamate, or iohexol.
Whenever there is a disparity between the two kidneys greater than 10%, performing a differential mGFR for each kidney with a combination of 51Cr-EDTA and 99mTc-DMSA. If eligible, the less functioning kidney should be donated.
Glomerular filtration rate thresholds for donation should be adapted for age and sex.
In patients older than 35 years, a GFR >80 ml/min/1.73 m2 is safe for donation.
Abdullah Raoof
2 years ago
What is a safe threshold level of kidney function to donate?
Long term outcome studies demonstrate a very small absolute increased risk of ESRD in large donor populations with mGFR in excess of 80 mL/min/1.73m2 where the mean age at donation was around 40-50 years.
A threshold GFR >80 mL/min/1.73m2 appears safe for donation in the 35 year and above age range.
Given the extended expected lifetime risk of over 60 years for a 20-year-old, recommendations for minimum GFR in younger donors are more conservative.
One study demonstrated an increased absolute lifetime risk in younger donors with GFR <90 mL/min/1.73m2, particularly those with additional risk factors .
A threshold for donation of >90 mL/min/1.73m2 has therefore been set for those <30 years.
For those >45 years the threshold renal function is predicated on post-donation GFR
(75% of pre-donation function) remaining above the lower limit of the age and gender-specific normal range. At all age and gender-specific GFR thresholds, predicted post-donation renal function in the long
term is based cautiously on loss of GFR each decade after age 40 of 6.5 mL/min/1.73m2 for men and 7.9 mL/min/1.73m2 in women. Accordingly if these thresholds are adopted, renal function will be expected to remain within the normal range up to age 80.
Advisory Threshold GFR Levels Considered Acceptable for
Living Kidney Donation*
Age (years) Threshold GFR (mL/min/1.73m2)
Male Female
20-29 90 90
30-34 80 80
35 80 80
40 80 80
45 80 80
50 80 80
55 80 75
60 76 70
65 71 64
70 67 59
75 63 54
80 58 49
References :
British Transplantation Society http://www.bts.org.uk March 2018 The Evaluation of Kidney Function in Living Kidney Donor Candidates .
Mohamed Essmat
2 years ago
According to the BTS guidelines :
A safe threshold level of pre-donation kidney function is one that leaves sufficient function after donation to maintain the donor in normal health (or minimal absolute reduction of health) without affecting lifespan.
This requires a definition of normal renal function and of the normal range of age-related change in renal function in healthy adults over time. It is reasonable to assume that a threshold which leaves the donor with normal age related kidney function after donation is safe.
This assumption must be supported by long-term post-donation health outcomes of kidney donors. These outcomes include:
-Early post donation kidney function after compensation of the residual kidney
-Lifetime rate of decline in kidney function after donation
-Any increased risk of ESRD and long-term mortality.
*Most series reporting long-term post-donation outcomes comprise mainly Caucasian donors who have been normotensive, non-diabetic and normo-albuminuric.
The mean age at donation of the cohorts has been around 45 years and the lower threshold for donation a GFR >80 mL/min/1.73m2 .
References:
1-El-Zoghby ZM, Stegall MD, Lager DJ, et al. Identifying specific causes of kidney allograft loss. Am J Transplant 2009; 9: 527-35.
2-Hariharan S, Adams MB, Brennan DC, et al. Recurrent and de novo glomerular disease after renal transplantation: a report from Renal Allograft Disease Registry (RADR). Transplantation 1999; 68: 635-41.
3-Briggs JD, Jones E. Recurrence of glomerulonephritis following renal transplantation. Scientific Advisory Board of the ERA-EDTA Registry.
Abhijit Patil
2 years ago
KDIGO Living Kidney Donor Work Group Guidelines 2017 state:
“We recommend a higher threshold value of GFR (≥90 mL/min per 1.73 m2) to routinely accept a donor candidate, and lower threshold value of GFR (<60 mL/min per 1.73 m2) to routinely decline a donor candidate, and a wide intermediate range of GFR (60-89 mL/min per 1.73 m2) in which transplant programs can individualize decisions based on other risk factors.”
BTS/RA Living Donor Kidney Transplantation Guidelines 2018
As shown in image
AMAL Anan
2 years ago
According to KDIGO guidelines 2017:
GFR is equal or above 90 ml/min is accepted for donation.
if GFR from 60-89 ml/min , it will be according to cost and benefit risk.
if GFR less than 60 ml/min must be avoided for donation.
According to BTS guidelines
The accepted age for donation is about 45 years old with GFR threshold for donation above 80 ml/min.
Wadia Elhardallo
2 years ago
According to British Transplantation Society Living Donor Kidney Transplantation Guidelines 2018:
dina omar
2 years ago
*According to KDIGO guidelines ( 2017): eGFRcr considered the initial test for donors. eGFR of 90 mL/min per 1.73 m2 or greater considered an acceptable , while donors with GFR < 60 mL/min should not be accepted for donation , more-over ; donors with eGFR 61–89 mL/min may be considered but individualization is a must depending on exclusion of additional risk factors of ESRD. In BTS guidelines 2018 : donors with GFR > 80 could be taken safely. But ,there are specific values for kidney donation according to : age and sex. If younger age than thirty years so high GFR more than 90 ml/min is preferable due to long time incidence of decreased GFR and vice versa in old age. The loss of GFR each decade after age of 40 is 6.5 mL/min for males and 7.9 mL/min in females.
rindhabibgmail-com
2 years ago
Threshold for donation according to BTS and KDIGO is different.
According to KDIGO >90 ML/MIN/ 1.7M2 had been set, while in BTS >80ml/min/1.7m2 is safe.
In between 61 to 90ml/min/1.7m2 eGFR should be individualized according to center transplantation program.
Mahmoud Hamada
2 years ago
I can not find my previous answer on that scenario!
Balaji Kirushnan
2 years ago
A safe threshold for kidney donation is attainment of normal GFR leaving behind sufficient nephron mass to maintain normal functions of the donor without affecting him/her life span…Both KDIGO and BTS guidelines have been issued for kidney donation…
KDIGO guidelines 2017 – Recommend eGFR using CKD EPI and if available mGFR by nuclear studies to determine eGFR…If eGFR is more than 90ml/min/m2 it is recommended to donate….any eGFR<60 ml/min/m2, the donor is not accepted…in between the GFR of 61-90ml/min/m2 it is recommended that an individualized approach is considered taking the risk factors into consideration….
BTS guidelines -2018 for living kidney donation….the age and gender specific values for kidney donation are considered and have been provided…They recommend mGFR by nuclear scan using DTPA, iohexol etc….In general GFR > 80ml/min/m2 is recommended as the cut off for kidney donation…for a age less than 30 years they recommend eGFR > 90ml/min/m2 as there is a lifetime risk of decrease in GFR later…..for those donors aged more than 55 years eGFR of 75ml/min/m2 in males and 70 ml/min/m2 in females is considered as the cut off…
The donor GFR may take 3 months post operatively to reach 75% of the pre operative GFR and this is considered normal to maintain GFR in the life time of the donor
The normal GFR decline after the age of 40 is 3 ml/min/m2 in males and 5 ml/min/m2 in females for every 5 years…This is considered while formulating the guidelines for kidney donation….
Giulio Podda
2 years ago
A threshold for donation of >90 mL/min/1.73m2 has been set for those <30 years (given the extended expected lifetime risk of over 60 years for a 20-year-old, recommendations for minimum GFR in younger donors are more conservative). The threshold for donation is normotensive, non-diabetic, non-albuminuric individual with GFR > 80ml/min/1.73sqm. as per BTS guidelines
A threshold GFR >80 mL/min/1.73m2 appears safe for donation in the 35 year and above age range.
For those >45 years the threshold renal function is predicated on post-donation GFR (75% of pre-donation function) remaining above the lower limit of the age and gender-specific normal range described above (-2SD below mean). At all age and gender-specific GFR thresholds, predicted post-donation renal function in the long term is based on loss of GFR each decade after age 40 of 6.5 mL/min/1.73m2 for men and 7.9 mL/min/1.73m2 in women. Perspective donor with an eGFR < 60 l/min is not suitable for donation. Potential donor candidates with eGFR 60–89 mL/min per 1.73 m2 could still be considered and the decision to proceed will rely on the work up to exclude additional risk factors to develop ESRD. Therefore, the overall medical condition is always recommended to be screened for donor selection. Also, these values are flexible in any case, as it is generally accepted that the eGFR declines with aging, independently from the presence of chronic kidney disease.
According to KDIGO guidelines (2017): –Donor candidates with GFR less than 60 mL/min per 1.73 m2 should not donate.
-If eGFR is between 60 and89 ml/min per 1.73 m2 the approval of donor candidates
should be individualized based on demographic and health profile in relation to the
transplant program’s acceptable risk threshold.
-If eGFR is 90 mL/min per 1.73 m2 or greater the potential donor is deemed acceptable
for donation.
-if donation is not precluded by the presence of asymmetry in GFR, parenchymal
abnormalities, vascular abnormalities, or urological abnormalities, the more severely
affected kidney should be used for donation.
Maksuda Begum
2 years ago
To accept a donor routinely, the GFR should be more than 90 ml/min/1.73 m2. But according to different guidelines a donor can be accepted with GFR above 60 ml/min/1.73 m2 in different age and sex. If the GFR below 60 ml/min/1.73 m2, the donor can not be accepted. According to BTS guidelines(2018):
Age (20-29) mGFR 100 (74-126) in male , 98 (72-125) in female.
Age 30-34 ,mGFR 100 (74-126) in male , 98 (72-125) in female.
Age (35) , mGFR 99 (73-126) in male , 98(72-125) in female.
Age 40, mGFR 96 (70-122) in male, 94 (68-122) in female.
Age 45 , mGFR 93 (67-119) in male , 91 (64-117) in female.
Age 50, mGFR 90 (63-116) in male , 87 (60-113) in female.
Age 55 mGFR 86 (60-112) in male , 83 (56-109) in female.
Age 60 mGFR 83 (57-109) in male , 79 (52-105) in female.
Age 65 mGFR 80 (54-106) in male , 75 (48-101) in female.
Age 70 mGFR 76 (50-102) in male , 71 (44-97) in female.
Age 75 mGFR 73 (47-99) in male , 67 (40-94) in female .
Age 80 mGFR 70 (44-96) in male , 63 (36-90) in female. According to KDIGO guidelines ( 2017):
eGFRcr is considered the initial test for most donors .
However, eGFRcys may be preferred for donors with variations in non-GFR determinants of eGFRcr: eg muscle mass or diet.
GFR of 90 mL/min per 1.73 m2 or greater considered an acceptable level of kidney donation, and donors with GFR less than 60 mL/min per 1.73 m2 should not donate.
Potential donors with eGFR 60–89 mL/min per 1.73 m2 still be considered depending on exclusion of additional risk factors of ESRD.
Huda Al-Taee
2 years ago
What is a safe threshold level of kidney function to donate?potential donor with GFR> 90 ML/MIN/1.73 M2 can donate safely.
potential donor with GFR of 90-60, need 2nd step evaluation and correction of hie GFR to his age, the decision will be individualised.
potential donors with GFR less than 60 should not donate.
Ahmed Omran
2 years ago
Safe kidney function threshold for kidney donation:
This aims at having sufficient function to maintain donor in normal health without affecting lifespan. This requires a definition of normal renal function and of the normal range of age-related change in renal function in healthy adults over time.. According to BTS guidelines(2018):
Age (20-29) mGFR 100 (74-126) in male , 98 (72-125) in female.
Age 30-34 ,mGFR 100 (74-126) in male , 98 (72-125) in female.
Age (35) , mGFR 99 (73-126) in male , 98(72-125) in female.
Age 40, mGFR 96 (70-122) in male, 94 (68-122) in female.
Age 45 , mGFR 93 (67-119) in male , 91 (64-117) in female.
Age 50, mGFR 90 (63-116) in male , 87 (60-113) in female.
Age 55 mGFR 86 (60-112) in male , 83 (56-109) in female.
Age 60 mGFR 83 (57-109) in male , 79 (52-105) in female.
Age 65 mGFR 80 (54-106) in male , 75 (48-101) in female.
Age 70 mGFR 76 (50-102) in male , 71 (44-97) in female.
Age 75 mGFR 73 (47-99) in male , 67 (40-94) in female .
Age 80 mGFR 70 (44-96) in male , 63 (36-90) in female. According to KDIGO guidelines ( 2017):
eGFRcr is considered the initial test for most donors .
However, eGFRcys may be preferred for donors with variations in non-GFR determinants of eGFRcr: eg muscle mass or diet. GFR of 90 mL/min per 1.73 m2 or greater considered an acceptable level of kidney donation, and donors with GFR less than 60 mL/min per 1.73 m2 should not donate. Potential donors with eGFR 60–89 mL/min per 1.73 m2 still be considered depending on exclusion of additional risk factors of ESRD.
Shereen Yousef
2 years ago
Donor selection is based mainly on the view of the associated risk to develop end stage renal disease post donation, strongly based on the estimated glomerular filtration rate (eGFR)
Two eGFR thresholds areconsidered:
a high threshold (90 mL/min per 1.73 m2) for young and healthy individuals with otherwise unremark-medical conditions, and a low threshold (60 mL/min per 1.73 m2), according
to the definition of Chronic kidney disease of stage III.
KIDIGO 2017 recommendations to accept a candidate routinely, they suggest an eGFR > 90 ml/min/1.73 m2 and < 60 ml/min/1.73 m2 to exclude the participant. For values in the middle decisions should be individualized and other risk factors should be considered.
These values are flexible
in any case, as it is in fact generally accepted that the eGFR declines with aging
independently from the presence of chronic kidney disease; therefore,
the overall medical condition is always recommended to be screened for donor selec-
tion.
Thus, potential donor candidates with eGFR 60–89 mL/min per 1.73 m2
could still be considered and the decision to proceed will rely on the work up to exclude
additional risk factors to develop ESRD.
Table 1. Identification of age-related kidney function safe thresholds to donate.
Similar to KDIGO, they recommend CKD-EPI + Cr as the initial test. This will identify and rule out potential donors with CKD (eGFR < 45 ml/min/1.73 m2). For the rest, GFR should be confirmed by mGFR with inulin clearance, 51Cr-EDTA, 125I-iothalamate, or iohexol (65).
Whenever there is a disparity between the two kidneys greater than 10%, they recommend performing a differential mGFR for each kidney with a combination of 51Cr-EDTA and 99mTc-DMSA. If eligible, the less functioning kidney should be donated.
GFR of 90 mL/min per 1.73 m2 or greater should be considered an acceptable level of kidney function for donation.
The decision to approve donor candidates with GFR 60 to 89 mL/min per 1.73 m2 should be individualized based on demographic and health profile in relation to the transplant program’s acceptable risk threshold.
Donor candidates with GFR less than 60 mL/min per 1.73 m2 should not donate.
When asymmetry in GFR, parenchymal abnormalities, vascular abnormalities, or urological abnormalities are present but do not preclude donation, the more severely affected kidney should be used for donation.
as per RA/BTS guidelines , 2018
the mean age at donation of the cohorts has been around 45 years and the lower threshold for donation a GFR >80 mL/min/1.73m2 Age and Gender-Specific GFR based on almost 3000 Healthy Potential UK living kidney donors threshold GFR (mL/min/1.73m2 ) Age (years) Male Female 20-29 90 90 30-34 80 80 35 80 80 40 80 80 45 80 80 50 80 80 55 80 80 60 76 70 70 67 59 75 63 54 80 58 49
amiri elaf
2 years ago
The KDIGO Recommendation:
GFR >/= 90 ml/min per 1.73m2 is acceptable for kidney donation.
GFR < 60 ml/min per 1.73m2 is not acceptable for kidney donation.
GFR of 60 – 89 ml/min per 1.73m2 is an intermediate range in which the decision should be individualized on the basis of the age and other clinical factorsin relation to the transplant center acceptance risk threshold.
· According to KDIGO: Clinical practice guideline on the evaluation and care of living kidney donors (2017)
GFR of 90 mL/min per 1.73 m2 or greater should be considered an acceptable level of kidney function for kidney donation, while donor candidates with GFR less than 60 mL/min per 1.73 m2 should not donate.
The decision to approve donor candidates with GFR 60 to 89 mL/min per 1.73 m2 should be individualized based on demographic and health profile in relation to the transplant program’s acceptable risk threshold.
Hussam Juda
2 years ago
What is a safe threshold level of kidney function to donate?
· KDIGO: Clinical practice guideline on the evaluation and care of living kidney donors (2017)
GFR of 90 mL/min per 1.73 m2 or greater should be considered an acceptable level of kidney function for kidney donation, while donor candidates with GFR less than 60 mL/min per 1.73 m2 should not donate.
The decision to approve donor candidates with GFR 60 to 89 mL/min per 1.73 m2 should be individualized based on demographic and health profile in relation to the transplant program’s acceptable risk threshold.
Age and Gender-Specific GFR based on almost 3000 Healthy Potential UK living kidney donors
Eusha Ansary
2 years ago
To accept a donor routinely, the GFR should be more than 90 ml/min/1.73 m2. But according to different guidelines a donor can be accepted with GFR above 60 ml/min/1.73 m2 in different age and sex. If the GFR below 60 ml/min/1.73 m2, the donor can not be accepted.
Zahid Nabi
2 years ago
Based on lack of evidence for a single GFR threshold from systematic review, a higher threshold value of GFR (≥90 mL/min/1.73 m2) should be used for the routine acceptance of a donor candidate, and a lower threshold value of GFR (<60 mL/min/1.73 m2) should be used to routinely decline a donor candidate. In the intermediate range of GFR (60 to 89 mL/min/1.73 m2) the decision to approve should be individualized based on demographic and health profile in relation to the transplant program’s acceptable risk threshold, including projected risk of kidney failure estimated from simultaneous consideration of all baseline factors
Marius Badal
2 years ago
The safe threshold level of kidney function to donate depends on the center to center and different guidelines from institutions.
Based on KDIGO guidelines 2017, it depends on the GFR, the higher it is the better it will be for the donor candidate that is if the GFR is greater than 90 ml/min/1.73m2. With this saying the lower the GFR the more likely the donor candidate will not be used which is a GFR of less than 60 ml/min/1.73 m2. Now based on the risk factors of the patient there is an intermediate range that can be used, and it is between 60-89 ml/min. the patient must be properly investigated, and the risk factors adequately controlled.
According to the Journal of Nephrology dialysis and transplantation 2013, it suggests that present recommendations for donor selection give major value to renal function, and as such the estimated GFR must be over 80 ml/min.
The other guideline is the BTS guidelines 2018, which demonstrates that a safe level of pre- donation kidney function is one that leaves sufficient function after the donation is made so that there is an adequate renal function for the donor to have a normal healthy kidney function. The GFR before donation must be such that after the patient has been transplanted it will not affect post-transplant GFR. Based on the BTS guidelines 2018, shows an expected GFR. Below is the table.
Hourmant, M., Lerat, L., and Karam.G., Nephrology Dialysis Transplantation (2013). Donation from old living donors: how safe is it? 28: 2010–2014
BTS guidelines 2018
KDIGO guidelines 2017
Dalia Ali
2 years ago
To accept a candidate routinely, the eGFR should be more than 90
ml/min/1.73 m2
and if the GFR below < 60 ml/min/1.73 m2 the donor should be excluded
For values in the middle decisions should be individualized and other risk factors should be considered. This recommendation was based on a meta-analysis with almost 5 million healthy subjects where they found that for an eGFR > 90 ml/min/1.73 m2, the life-long risk of developing CKD was approximately 1% of any age and race. For subjects aged 60 years or older with an eGFR between 60 and 89 ml/min/1.73 m2, the risk is less than 1%
Reference
Gustavo Laham*, Juan Pablo Ponti and Gervasio Soler Pujol. Assessing Renal Function for Kidney Donation. How Low Is Too Low?. Frontiers in Medicine | http://www.frontiersin.org
Ajay Kumar Sharma
Admin
2 years ago
Many thanks Dr Y Saini, Dr Heba and Dr F Batista,
Let us move to week 4.
Ajay
Yashu Saini
2 years ago
BTS Guidelines suggests the safe threshold level of kidney function to donate as follows:
Potential donors should be evaluated initially using estimated glomerular filtration rate (eGFR), using most widely accepted CKD-EPI formula.
Then for a more detailed assessment GFR must be further assessed by measured GFR method (mGFR) such as clearance of 51Cr-EDTA, 125iothalamate or iohexol.
A safe threshold level of kidney function during pre-donation period is considered when it leaves sufficient function after donation so that donor health remains normal without affecting donor’s lifespan.
The threshold for donation is normotensive, non-diabetic, non-albuminuric individual with GFR > 80ml/min/1.73sqm as per BTS guidelines.
whereas as per KDOQI following are the guidelines for safe threshold for donation:
GFRof 90mL/minper1.73m2 or greater should be considered an acceptable level of kidney function for donation.
Donor candidates with GFR 60 to 89mL/min per 1.73m2 should be individualized based on demographic and health profile in relation to the transplant program’s acceptable risk threshold.
Donor candidates with GFR less than 60 mL/min per 1.73 m2 should not donate.
In case of asymmetry in GFR, parenchymal abnormalities, vascular abnormalities, or urological abnormalities are, the more severely affected kidney should be used for donation.
Heba Wagdy
2 years ago
The safe threshold is the predonation kidney function that maintain the donor in normal health without affecting life span and keep the donor with normal age related kidney function after donation.
Recommended threshold levels are presented in the table.
KDIGO guidelines recommend accepting the donor if GFR</=90 and eclusion if GFR<60 and for those with GFR ranging from 60 to 90, assessment of risk of renal impairment versus program’s pre-established risk threshold and if the post donation risk is higher than the program’s acceptable threshold, the donor is declined.
BTS/RA Living Donor Kidney Transplantation Guidelines 2018
Mandelbrot DA, Reese PP, Garg N, Thomas CP, Rodrigue JR, Schinstock C, Doshi M, Cooper M, Friedewald J, Naik AS, Kaul DR. KDOQI US commentary on the 2017 KDIGO clinical practice guideline on the evaluation and care of living kidney donors. American Journal of Kidney Diseases. 2020 Mar 1;75(3):299-316.
What is a safe threshold level of kidney function for donation on to donate?very small risk of 80 ml/min/1.7m2 where the mean age at donation was around 40 -50 years so threshold eGFR .80 ml/min////1.7m2 is safe in 35 years and above range but those with additional risk factor threashold >90.
for those above 60 y male should >70 eGFR.
those 65 y male eGFR should be .71eGFR.
those 70 yrs male eGFR .67eGFR.
those 80 yrs male eGFR 58
BTS/guidelines kidney transplantation. for donation
fakhriya Alalawi
2 years ago
Based on BTS LDKT Guidelines 4th edition consultation draft, December 2017:
Initial evaluation of donor candidates should be using estimated glomerular filtration rate (eGFR), expressed as mL/min/1.73m2 computed from a creatinine assay standardised to the International Reference Standard. (B1)
GFR must subsequently be assessed by a reference measured method (mGFR) such as clearance of 51Cr-EDTA, 125iothalamate or Iohexol performed according to guidelines published by the British Society of Nuclear Medicine. (B1)
A safe threshold level of pre-donation kidney function is one that leaves sufficient function after donation to maintain the donor in normal health (or minimal absolute reduction of health) without affecting lifespan.
The following table shows Advisory Threshold Measured GFR Considered Safe for Donation:
Sahar elkharraz
2 years ago
The safe threshold level of kidney function to donate if GFR more than 80ml/min/1.73m2.BTC guideline recommended donation according estimate GFR in respect of age
GFR> 90 between age 18-30
GFR> 85 ml/min/1.73m2 between age 30- 40 y
GFR>80 ml/min/1.73m2 between age 41- 65 y
GFR>75 ml/min/1.73m2 at age > 65 years
Huda Saadeddin
2 years ago
Advisory GFR Thresholds for Donation
Pre-donation mGFR should be such that the predicted post-donation GFR remains within the gender and age-specific normal range within the donor’s lifetime. Recommended threshold levels are defined in Table 5.5.2. (B1)
Again The risk of end-stage renal disease (ESRD) after donation is no higher than that of the general population. However, there is a very small absolute increased lifetime risk of ESRD following donation for which the potential donor must be consented.
reference BTS/RA Living Donor Kidney Transplantation Guidelines 2018
Reem Younis
2 years ago
-A safe threshold level of pre-donation kidney function is one that leaves sufficient function after donation to maintain the donor in normal health (or minimal absolute reduction of health) without affecting lifespan. This requires a definition of normal renal function and of the normal range of age-related change in renal function in
healthy adults over time.
-GFR of 90 mL/min per 1.73 m2 or greater should be considered an acceptable level of kidney function for donation.
– The decision to approve donor candidates with GFR 60 to 89 mL/min per 1.73 m2 should be individualized based on demographic and health profile in relation to the transplant program’s acceptable risk threshold.
– Donor candidates with GFR less than 60 mL/min per
1.73 m2 should not donate. Age and Gender-Specific GFR based on almost 3000 Healthy Potential UK living kidney donors
Age (years) Measured GFR (mL/min/1.73m2)
Male Female
20-29 100 (74-126) 98 (72-125)
30-34 100 (74-126) 98 (72-125)
35 99 (73-126) 98 (72-125)
40 96 (70-122) 94 (68-121)
45 93 (67-119) 91 (64-117)
50 90 (63-116) 87 (60-113)
55 86 (60-112) 83 (56-109)
60 83 (57-109) 79 (52-105)
65 80 (54-106) 75 (48-101)
70 76 (50-102) 71 (44-97)
75 73 (47-99) 67 (40-94)
80 70 (44-96) 63 (36-90) Referrences:
-KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors August 2017 . Volume 101 . Number 8S-1.
-BTS/RA Living Donor Kidney Transplantation Guidelines 2018
Dear All,
Please see the BTS guidelines posted in the journal club in addition to the KDOQI GUIDELINES
The eGFR threshold is different according to age and gender. the BTS guideline summarized in Table 5.5.1
with advancement in age, the lowest threshold is 70 in males and 63 for females (for age 80 as an example). This is 90 (male) and 87 (female) for the age of 50.
It is important to recognize the limitations of the current evidence base, as the answer to this question is based on a series of reports with long-term post-donation results comprising mainly Caucasians, normotensive, non-diabetic and normoalbuminuric donors, with a mean age of 45 years, population that is not the majority of donations nowadays.
In this population, the lowest threshold for donation was a GFR >80 mL/min/1.73m2.
GFR >80 ml/min for pt age 40 years old
and according to age group
with no albuminuria ,no hematuria
A safe threshold of kidney function before to donation is one that leaves enough function after donation to keep the donor in normal health (or minimum absolute decline of health) without impacting longevity.
The majority of series documenting long-term post-donation outcomes mostly include:
normotensive,
non-diabetic, and normoalbuminuric
Caucasian donors.
The lower BTS/RA Living Donor Kidney Transplantation Guidelines criteria for donation is a GFR >80 mL/min/1.73m2, and the cohorts’ median age at donation has been about 45 years.
We must asses before kidney donation 3 items :
Early kidney function upon donation, following compensation for the remaining kidney
lifetime rate of kidney function loss following donation
Risk of ESKD in this donor
Ref :
BTS
A safe threshold level of pre-donation kidney function is one that leaves sufficient function after donation to maintain the donor in normal health (or minimal absolute reduction of health) without affecting lifespan.
When the GFR is less than 60 mL/min/1.73 m2, regardless of age, the KDIGO guidelines prohibit donation.
A GFR of 60 mL/min/1.73 m2 appears to be an absolute no-no for donation. A GFR greater than 90 mL/min/1.73 m2 is never considered incompatible with donation, even for the youngest candidates. (2017) (KL Lentine et al.).
The age and gender-specific GFR based on almost 3000 Healthy Potential UK living kidney donors
Threshold GFR (mL/min/1.73m2 )
Age (years) Male Female
20-29 90 90
30-34 80 80
35 80 80
40 80 80
45 80 80
50 80 80
55 80 80
60 76 70
70 67 59
75 63 54
80 58 4
References:
-KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors August 2017 . Volume 101 . Number 8S-1.
-BTS/RA Living Donor Kidney Transplantation Guidelines 2018
As per the British society guidelines 2017, attached safe threshold of kidney function for donation.
A threshold of GFR above 80 ml/min/m2 at age of 45, appears acceptable.
Pre-donation mGFR should be such that the predicted post-donation GFR remains within the gender and age-specific normal range within the donor’s lifetime.
BTS/RA Living Donor Kidney Transplantation Guidelines 2018
According to BTS/RA living donor kidney transplantation guidelines
The age and gender -specific GFRs are considered safe to donate
A threshold of GFR more than 80 mi/min/1.73 m2 appears safe for donation in the age 35 years.
According to KDIGO guidelines : donor candidates with GFR more than 90 mi/min/1.73 m2 should be considered acceptable, and those with GFR less than 60 mi/min/1.73 m2
should be excluded , the decision about donors with GFR between them should be individualized according to donor health.
What is a safe threshold level of kidney function to donate?with aging kidneys like any organ are exposed to aging in the form of glomerulosclerosis which can be estimated by this equation ([age/2]−10) which is usually used by pathologists.
each age group there is accepted GFR which consider normal and safe to be accepted as a potential donor. also accepted GFR differs from male to female because of different muscle bulk.
the following diagram accepted kidney function based on both age and sex
References :
British Transplantation Society http://www.bts.org.uk March 2018 The Evaluation of Kidney Function in Living Kidney Donor Candidates.
What is a safe threshold level of kidney function to donate?
A safe threshold level of pre-donation kidney function is the one that keep sufficient kidney function after donation to ensure normal health to the donor, without affecting lifespan. For this we need to define normal kidney function and the normal range of changes in kidney function related to age over time.
A threshold GFR >80 mL/min/1.73m2 appears safe for donation in the 35 year and above age range.
A threshold for donation of >90 mL/min/1.73m2 has therefore been set for those <30 years.
Age (years) Threshold GFR (mL/min/1.73m2)
Male Female
20 – 29 90 90
30 – 50 80 80
55 80 75
60 76 70
65 71 64
70 67 59
75 63 54
80 49 49
Reference
BTG
4. What is a safe threshold level of kidney function to donate?
According to 2017 KDIGO guidelines recommend GFR 90 ml/min/m2 or higher is considered an acceptable level for donation. GFR lower than 60 ml/min/m2 is not accepted.
Age & gender specific GFR for potential UK living kidney donors:
Age (20-29y) ——à 90 ml/min/m2 for male and female donors.
Age (30-55y) ——à 80 ml/min/m2 for male and female donors.
Age (56-60y) —–à 76 ml/min/m2 for male donors, and 70 ml/min/m2 for female donors.
Age (61-70y) —–à67 ml/min/m2 for male donors, and 59 ml/min/m2 for female donors.
Age (71-75y) —–à63 ml/min/m2 for male donors, and 54 ml/min/m2 for female donors.
Age (76-80y) —-à 58 ml/min/m2 for male donors and 54 ml/min/m2 for female donors.
· The age and gender-specific GFR based on almost 3000 Healthy Potential UK living kidney donors
Threshold GFR (mL/min/1.73m2 )
Age (years) Male Female
20-29 90 90
30-34 80 80
35 80 80
40 80 80
45 80 80
50 80 80
55 80 80
60 76 70
70 67 59
75 63 54
80 58 4
References:
-KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors August 2017 . Volume 101 . Number 8S-1.
-BTS/RA Living Donor Kidney Transplantation Guidelines 2018
According to BTS guidelines, people below 30 years of age who have a GFR above 90 ml/min and people older than 30 having a GFR more than 80 ml/min can donate. However, for people over 50 years of age, this number is reduced to 75, 70, 64, 59, 54 and 49 for females at 55, 60,65,70,75 and 80 years old. This safe threshold refers to no risk for having a normal life without kidney failure.
According to BTS guidelines eGFR between 90-60 ml/min/1.7m
The safest threshold for donation eGFR should be exceeding 90 ml /min /m2 in general population, with the advancement of age, older donors can be considered for donation according their age related standard for eGFR as they are less likely to develop renal disease after their old age with meticulous selection.
According to the American society of transplantation.
2016 Jan;16(1):171-80.
doi: 10.1111/ajt.13540.
Renal transplantation evaluation require careful selection of the donor as the life time risk of ESRD in donors is always a concern especially after the Norwegian study and the JAMA 2014 publication which prove that donors have a life risk of ESRD as compared to non donors…But however the absolute risk of ESRD is low and careful selection of the donors can mitigate the risk of ESRD in the donors….
The safe threshold for GFR donation is different according to various guidelines
The KDIGO guidelines in 2017 state that GFR >90ml/min/m2 is needed for safe threshold for kidney donation….GFR < 60ml/min/m2 is contraindicated for kidney donation….The GFR between 60 – 90 ml/min/m2 they recommend a risk assessment and individualized approach for kidney donation recommendation…
The British Transplantation Society guidelines in 2018 recommend age related cut off for GFR donation….In general GFR>80ml/min/m2 for an average age of 35 years is recommended…they have incorporated age related GFR decline that is 6.6ml/min/m2 in males and 7.7 ml/min/m2 in females every decade after the age of 40 years and recommend GFR threshold for every age group….If the age group is less than 35 years they recommend GFR of >90 ml/min/m2 as they have life longevity which exposes them to various lifestyle diseases and autoimmune conditions…..At the age of 80 years the acceptable threshold for GFR as 58 and 49 ml/minm2. The BTS guidelines recommend that the post donation GFR should be sufficient enough to provide normal renal functions later in life…
Potential donors between 18 and 30 years old should have a GFR ≥ 90 ml/min/1.73 m2 to be accepted, a GFR ≥ 85 ml/min/1.73 m2 for donors between 31 and 40 years old, a GFR ≥ 80 ml/min/1.73 m2 for those 41 to 65 years old, and a GFR ≥ 75 ml/min/1.73 m2 for those >65 years old
KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors
CHAPTER 5: PREDONATION KIDNEY FUNCTIONEvaluation
British Transplantation Society-BTS 2018
Rule out potential donors with CKD (eGFR < 45 ml/min/1.73 m2).
GFR > 45 ml/min/1.73 m2, should be confirmed by mGFR with inulin clearance, 51Cr-EDTA, 125I-iothalamate, or iohexol.
Whenever there is a disparity between the two kidneys greater than 10%, performing a differential mGFR for each kidney with a combination of 51Cr-EDTA and 99mTc-DMSA. If eligible, the less functioning kidney should be donated.
Glomerular filtration rate thresholds for donation should be adapted for age and sex.
In patients older than 35 years, a GFR >80 ml/min/1.73 m2 is safe for donation.
What is a safe threshold level of kidney function to donate?
Long term outcome studies demonstrate a very small absolute increased risk of ESRD in large donor populations with mGFR in excess of 80 mL/min/1.73m2 where the mean age at donation was around 40-50 years.
A threshold GFR >80 mL/min/1.73m2 appears safe for donation in the 35 year and above age range.
Given the extended expected lifetime risk of over 60 years for a 20-year-old, recommendations for minimum GFR in younger donors are more conservative.
One study demonstrated an increased absolute lifetime risk in younger donors with GFR <90 mL/min/1.73m2, particularly those with additional risk factors .
A threshold for donation of >90 mL/min/1.73m2 has therefore been set for those <30 years.
For those >45 years the threshold renal function is predicated on post-donation GFR
(75% of pre-donation function) remaining above the lower limit of the age and gender-specific normal range. At all age and gender-specific GFR thresholds, predicted post-donation renal function in the long
term is based cautiously on loss of GFR each decade after age 40 of 6.5 mL/min/1.73m2 for men and 7.9 mL/min/1.73m2 in women. Accordingly if these thresholds are adopted, renal function will be expected to remain within the normal range up to age 80.
Advisory Threshold GFR Levels Considered Acceptable for
Living Kidney Donation*
Age (years) Threshold GFR (mL/min/1.73m2)
Male Female
20-29 90 90
30-34 80 80
35 80 80
40 80 80
45 80 80
50 80 80
55 80 75
60 76 70
65 71 64
70 67 59
75 63 54
80 58 49
References :
British Transplantation Society http://www.bts.org.uk March 2018 The Evaluation of Kidney Function in Living Kidney Donor Candidates .
According to the BTS guidelines :
A safe threshold level of pre-donation kidney function is one that leaves sufficient function after donation to maintain the donor in normal health (or minimal absolute reduction of health) without affecting lifespan.
This requires a definition of normal renal function and of the normal range of age-related change in renal function in healthy adults over time. It is reasonable to assume that a threshold which leaves the donor with normal age related kidney function after donation is safe.
This assumption must be supported by long-term post-donation health outcomes of kidney donors. These outcomes include:
-Early post donation kidney function after compensation of the residual kidney
-Lifetime rate of decline in kidney function after donation
-Any increased risk of ESRD and long-term mortality.
*Most series reporting long-term post-donation outcomes comprise mainly Caucasian donors who have been normotensive, non-diabetic and normo-albuminuric.
The mean age at donation of the cohorts has been around 45 years and the lower threshold for donation a GFR >80 mL/min/1.73m2 .
References:
1-El-Zoghby ZM, Stegall MD, Lager DJ, et al. Identifying specific causes of kidney allograft loss. Am J Transplant 2009; 9: 527-35.
2-Hariharan S, Adams MB, Brennan DC, et al. Recurrent and de novo glomerular disease after renal transplantation: a report from Renal Allograft Disease Registry (RADR). Transplantation 1999; 68: 635-41.
3-Briggs JD, Jones E. Recurrence of glomerulonephritis following renal transplantation. Scientific Advisory Board of the ERA-EDTA Registry.
KDIGO Living Kidney Donor Work Group Guidelines 2017 state:
“We recommend a higher threshold value of GFR (≥90 mL/min per 1.73 m2) to routinely accept a donor candidate, and lower threshold value of GFR (<60 mL/min per 1.73 m2) to routinely decline a donor candidate, and a wide intermediate range of GFR (60-89 mL/min per 1.73 m2) in which transplant programs can individualize decisions based on other risk factors.”
BTS/RA Living Donor Kidney Transplantation Guidelines 2018
As shown in image
According to KDIGO guidelines 2017:
GFR is equal or above 90 ml/min is accepted for donation.
if GFR from 60-89 ml/min , it will be according to cost and benefit risk.
if GFR less than 60 ml/min must be avoided for donation.
According to BTS guidelines
The accepted age for donation is about 45 years old with GFR threshold for donation above 80 ml/min.
According to British Transplantation Society Living Donor Kidney Transplantation Guidelines 2018:
*According to KDIGO guidelines ( 2017): eGFRcr considered the initial test for donors. eGFR of 90 mL/min per 1.73 m2 or greater considered an acceptable , while donors with GFR < 60 mL/min should not be accepted for donation , more-over ; donors with eGFR 61–89 mL/min may be considered but individualization is a must depending on exclusion of additional risk factors of ESRD. In BTS guidelines 2018 : donors with GFR > 80 could be taken safely. But ,there are specific values for kidney donation according to : age and sex. If younger age than thirty years so high GFR more than 90 ml/min is preferable due to long time incidence of decreased GFR and vice versa in old age. The loss of GFR each decade after age of 40 is 6.5 mL/min for males and 7.9 mL/min in females.
Threshold for donation according to BTS and KDIGO is different.
According to KDIGO >90 ML/MIN/ 1.7M2 had been set, while in BTS >80ml/min/1.7m2 is safe.
In between 61 to 90ml/min/1.7m2 eGFR should be individualized according to center transplantation program.
I can not find my previous answer on that scenario!
A safe threshold for kidney donation is attainment of normal GFR leaving behind sufficient nephron mass to maintain normal functions of the donor without affecting him/her life span…Both KDIGO and BTS guidelines have been issued for kidney donation…
KDIGO guidelines 2017 – Recommend eGFR using CKD EPI and if available mGFR by nuclear studies to determine eGFR…If eGFR is more than 90ml/min/m2 it is recommended to donate….any eGFR<60 ml/min/m2, the donor is not accepted…in between the GFR of 61-90ml/min/m2 it is recommended that an individualized approach is considered taking the risk factors into consideration….
BTS guidelines -2018 for living kidney donation….the age and gender specific values for kidney donation are considered and have been provided…They recommend mGFR by nuclear scan using DTPA, iohexol etc….In general GFR > 80ml/min/m2 is recommended as the cut off for kidney donation…for a age less than 30 years they recommend eGFR > 90ml/min/m2 as there is a lifetime risk of decrease in GFR later…..for those donors aged more than 55 years eGFR of 75ml/min/m2 in males and 70 ml/min/m2 in females is considered as the cut off…
The donor GFR may take 3 months post operatively to reach 75% of the pre operative GFR and this is considered normal to maintain GFR in the life time of the donor
The normal GFR decline after the age of 40 is 3 ml/min/m2 in males and 5 ml/min/m2 in females for every 5 years…This is considered while formulating the guidelines for kidney donation….
A threshold for donation of >90 mL/min/1.73m2 has been set for those <30 years (given the extended expected lifetime risk of over 60 years for a 20-year-old, recommendations for minimum GFR in younger donors are more conservative).
The threshold for donation is normotensive, non-diabetic, non-albuminuric individual with GFR > 80ml/min/1.73sqm. as per BTS guidelines
A threshold GFR >80 mL/min/1.73m2 appears safe for donation in the 35 year and above age range.
For those >45 years the threshold renal function is predicated on post-donation GFR (75% of pre-donation function) remaining above the lower limit of the age and gender-specific normal range described above (-2SD below mean). At all age and gender-specific GFR thresholds, predicted post-donation renal function in the long term is based on loss of GFR each decade after age 40 of 6.5 mL/min/1.73m2 for men and 7.9 mL/min/1.73m2 in women.
Perspective donor with an eGFR < 60 l/min is not suitable for donation.
Potential donor candidates with eGFR 60–89 mL/min per 1.73 m2 could still be considered and the decision to proceed will rely on the work up to exclude additional risk factors to develop ESRD. Therefore, the overall medical condition is always recommended to be screened for donor selection. Also, these values are flexible in any case, as it is generally accepted that the eGFR declines with aging, independently from the presence of chronic kidney disease.
Advisory Threshold GFR Levels Considered Acceptable for Living Kidney Donation
Age (years) Measured GFR (mL/min/1.73m2)
Male Female
20-29 100 (74-126) 98 (72-125)
30-34 100 (74-126) 98 (72-125)
35 99 (73-126) 98 (72-125)
40 96 (70-122) 94 (68-121)
45 93 (67-119) 91 (64-117)
50 90 (63-116) 87 (60-113)
55 86 (60-112) 83 (56-109)
60 83 (57-109) 79 (52-105)
65 80 (54-106) 75 (48-101)
70 76 (50-102) 71 (44-97)
75 73 (47-99) 67 (40-94)
80 70 (44-96) 63 (36-90)
According to KDIGO guidelines (2017):
–Donor candidates with GFR less than 60 mL/min per 1.73 m2 should not donate.
-If eGFR is between 60 and89 ml/min per 1.73 m2 the approval of donor candidates
should be individualized based on demographic and health profile in relation to the
transplant program’s acceptable risk threshold.
-If eGFR is 90 mL/min per 1.73 m2 or greater the potential donor is deemed acceptable
for donation.
-if donation is not precluded by the presence of asymmetry in GFR, parenchymal
abnormalities, vascular abnormalities, or urological abnormalities, the more severely
affected kidney should be used for donation.
To accept a donor routinely, the GFR should be more than 90 ml/min/1.73 m2. But according to different guidelines a donor can be accepted with GFR above 60 ml/min/1.73 m2 in different age and sex. If the GFR below 60 ml/min/1.73 m2, the donor can not be accepted.
According to BTS guidelines(2018):
Age (20-29) mGFR 100 (74-126) in male , 98 (72-125) in female.
Age 30-34 ,mGFR 100 (74-126) in male , 98 (72-125) in female.
Age (35) , mGFR 99 (73-126) in male , 98(72-125) in female.
Age 40, mGFR 96 (70-122) in male, 94 (68-122) in female.
Age 45 , mGFR 93 (67-119) in male , 91 (64-117) in female.
Age 50, mGFR 90 (63-116) in male , 87 (60-113) in female.
Age 55 mGFR 86 (60-112) in male , 83 (56-109) in female.
Age 60 mGFR 83 (57-109) in male , 79 (52-105) in female.
Age 65 mGFR 80 (54-106) in male , 75 (48-101) in female.
Age 70 mGFR 76 (50-102) in male , 71 (44-97) in female.
Age 75 mGFR 73 (47-99) in male , 67 (40-94) in female .
Age 80 mGFR 70 (44-96) in male , 63 (36-90) in female.
According to KDIGO guidelines ( 2017):
eGFRcr is considered the initial test for most donors .
However, eGFRcys may be preferred for donors with variations in non-GFR determinants of eGFRcr: eg muscle mass or diet.
GFR of 90 mL/min per 1.73 m2 or greater considered an acceptable level of kidney donation, and donors with GFR less than 60 mL/min per 1.73 m2 should not donate.
Potential donors with eGFR 60–89 mL/min per 1.73 m2 still be considered depending on exclusion of additional risk factors of ESRD.
What is a safe threshold level of kidney function to donate?potential donor with GFR> 90 ML/MIN/1.73 M2 can donate safely.
potential donor with GFR of 90-60, need 2nd step evaluation and correction of hie GFR to his age, the decision will be individualised.
potential donors with GFR less than 60 should not donate.
Safe kidney function threshold for kidney donation:
This aims at having sufficient function to maintain donor in normal health without affecting lifespan. This requires a definition of normal renal function and of the normal range of age-related change in renal function in healthy adults over time..
According to BTS guidelines(2018):
Age (20-29) mGFR 100 (74-126) in male , 98 (72-125) in female.
Age 30-34 ,mGFR 100 (74-126) in male , 98 (72-125) in female.
Age (35) , mGFR 99 (73-126) in male , 98(72-125) in female.
Age 40, mGFR 96 (70-122) in male, 94 (68-122) in female.
Age 45 , mGFR 93 (67-119) in male , 91 (64-117) in female.
Age 50, mGFR 90 (63-116) in male , 87 (60-113) in female.
Age 55 mGFR 86 (60-112) in male , 83 (56-109) in female.
Age 60 mGFR 83 (57-109) in male , 79 (52-105) in female.
Age 65 mGFR 80 (54-106) in male , 75 (48-101) in female.
Age 70 mGFR 76 (50-102) in male , 71 (44-97) in female.
Age 75 mGFR 73 (47-99) in male , 67 (40-94) in female .
Age 80 mGFR 70 (44-96) in male , 63 (36-90) in female.
According to KDIGO guidelines ( 2017):
eGFRcr is considered the initial test for most donors .
However, eGFRcys may be preferred for donors with variations in non-GFR determinants of eGFRcr: eg muscle mass or diet.
GFR of 90 mL/min per 1.73 m2 or greater considered an acceptable level of kidney donation, and donors with GFR less than 60 mL/min per 1.73 m2 should not donate.
Potential donors with eGFR 60–89 mL/min per 1.73 m2 still be considered depending on exclusion of additional risk factors of ESRD.
Donor selection is based mainly on the view of the associated risk to develop end stage renal disease post donation, strongly based on the estimated glomerular filtration rate (eGFR)
Two eGFR thresholds are considered:
a high threshold (90 mL/min per 1.73 m2) for young and healthy individuals with otherwise unremark-medical conditions, and a low threshold (60 mL/min per 1.73 m2), according
to the definition of Chronic kidney disease of stage III.
KIDIGO 2017 recommendations to accept a candidate routinely, they suggest an eGFR > 90 ml/min/1.73 m2 and < 60 ml/min/1.73 m2 to exclude the participant.
For values in the middle decisions should be individualized and other risk factors should be considered.
These values are flexible
in any case, as it is in fact generally accepted that the eGFR declines with aging
independently from the presence of chronic kidney disease; therefore,
the overall medical condition is always recommended to be screened for donor selec-
tion.
Thus, potential donor candidates with eGFR 60–89 mL/min per 1.73 m2
could still be considered and the decision to proceed will rely on the work up to exclude
additional risk factors to develop ESRD.
Table 1. Identification of age-related kidney function safe thresholds to donate.
Age (Years) Threshold GFR (mL/min/1.73 m
Male. Female
20–29. 90. 90
30–34. 80. 80
35. 80. 80
40. 80. 80
45. 80. 80
50. 80. 80
55. 80. 75
60. 76. 70
65. 71. 64
70. 67. 59
75. 63. 54
80. 58. 49
British Transplantation Society-BTS 2018
Similar to KDIGO, they recommend CKD-EPI + Cr as the initial test. This will identify and rule out potential donors with CKD (eGFR < 45 ml/min/1.73 m2). For the rest, GFR should be confirmed by mGFR with inulin clearance, 51Cr-EDTA, 125I-iothalamate, or iohexol (65).
Whenever there is a disparity between the two kidneys greater than 10%, they recommend performing a differential mGFR for each kidney with a combination of 51Cr-EDTA and 99mTc-DMSA. If eligible, the less functioning kidney should be donated.
Maria Irene Bellini,Vito Cantisani, Living Kidney Donation: Practical Considerations on Setting Up a Program,2021
(as per KDIGO guidelines , 2017)
as per RA/BTS guidelines , 2018
the mean age at donation of the cohorts has been around 45 years and the lower threshold for donation a GFR >80 mL/min/1.73m2
Age and Gender-Specific GFR based on almost 3000 Healthy Potential UK living kidney donors
threshold GFR (mL/min/1.73m2 )
Age (years) Male Female
20-29 90 90
30-34 80 80
35 80 80
40 80 80
45 80 80
50 80 80
55 80 80
60 76 70
70 67 59
75 63 54
80 58 49
The KDIGO Recommendation:
GFR >/= 90 ml/min per 1.73m2 is acceptable for kidney donation.
GFR < 60 ml/min per 1.73m2 is not acceptable for kidney donation.
GFR of 60 – 89 ml/min per 1.73m2 is an intermediate range in which the decision should be individualized on the basis of the age and other clinical factorsin relation to the transplant center acceptance risk threshold.
What is a safe threshold level of kidney function to donate?
· According to The Renal Association (RA) and British Transplantation Society (BTS): Guidelines for living donor kidney transplantation, 4th edition (2018)
The mean age at donation of the cohorts has been around 45 years and the lower threshold for donation a GFR >80 mL/min/1.73m2
Age and Gender-Specific GFR based on almost 3000 Healthy Potential UK living kidney donors
Threshold GFR (mL/min/1.73m2 )
Age (years) Male Female
20-29 90 90
30-34 80 80
35 80 80
40 80 80
45 80 80
50 80 80
55 80 80
60 76 70
70 67 59
75 63 54
80 58 49
· According to KDIGO: Clinical practice guideline on the evaluation and care of living kidney donors (2017)
GFR of 90 mL/min per 1.73 m2 or greater should be considered an acceptable level of kidney function for kidney donation, while donor candidates with GFR less than 60 mL/min per 1.73 m2 should not donate.
The decision to approve donor candidates with GFR 60 to 89 mL/min per 1.73 m2 should be individualized based on demographic and health profile in relation to the transplant program’s acceptable risk threshold.
What is a safe threshold level of kidney function to donate?
· KDIGO: Clinical practice guideline on the evaluation and care of living kidney donors (2017)
GFR of 90 mL/min per 1.73 m2 or greater should be considered an acceptable level of kidney function for kidney donation, while donor candidates with GFR less than 60 mL/min per 1.73 m2 should not donate.
The decision to approve donor candidates with GFR 60 to 89 mL/min per 1.73 m2 should be individualized based on demographic and health profile in relation to the transplant program’s acceptable risk threshold.
· According to The Renal Association (RA) and British Transplantation Society (BTS): Guidelines for living donor kidney transplantation, 4th edition (2018)
The mean age at donation of the cohorts has been around 45 years and the lower threshold for donation a GFR >80 mL/min/1.73m2
Age and Gender-Specific GFR based on almost 3000 Healthy Potential UK living kidney donors
To accept a donor routinely, the GFR should be more than 90 ml/min/1.73 m2. But according to different guidelines a donor can be accepted with GFR above 60 ml/min/1.73 m2 in different age and sex. If the GFR below 60 ml/min/1.73 m2, the donor can not be accepted.
Based on lack of evidence for a single GFR threshold from systematic review, a higher threshold value of GFR (≥90 mL/min/1.73 m2) should be used for the routine acceptance of a donor candidate, and a lower threshold value of GFR (<60 mL/min/1.73 m2) should be used to routinely decline a donor candidate.
In the intermediate range of GFR (60 to 89 mL/min/1.73 m2) the decision to approve should be individualized based on demographic and health profile in relation to the transplant program’s acceptable risk threshold, including projected risk of kidney failure estimated from simultaneous consideration of all baseline factors
The safe threshold level of kidney function to donate depends on the center to center and different guidelines from institutions.
Based on KDIGO guidelines 2017, it depends on the GFR, the higher it is the better it will be for the donor candidate that is if the GFR is greater than 90 ml/min/1.73m2. With this saying the lower the GFR the more likely the donor candidate will not be used which is a GFR of less than 60 ml/min/1.73 m2. Now based on the risk factors of the patient there is an intermediate range that can be used, and it is between 60-89 ml/min. the patient must be properly investigated, and the risk factors adequately controlled.
According to the Journal of Nephrology dialysis and transplantation 2013, it suggests that present recommendations for donor selection give major value to renal function, and as such the estimated GFR must be over 80 ml/min.
The other guideline is the BTS guidelines 2018, which demonstrates that a safe level of pre- donation kidney function is one that leaves sufficient function after the donation is made so that there is an adequate renal function for the donor to have a normal healthy kidney function. The GFR before donation must be such that after the patient has been transplanted it will not affect post-transplant GFR. Based on the BTS guidelines 2018, shows an expected GFR. Below is the table.
Hourmant, M., Lerat, L., and Karam.G., Nephrology Dialysis Transplantation (2013). Donation from old living donors: how safe is it? 28: 2010–2014
BTS guidelines 2018
KDIGO guidelines 2017
To accept a candidate routinely, the eGFR should be more than 90
ml/min/1.73 m2
and if the GFR below < 60 ml/min/1.73 m2 the donor should be excluded
For values in the middle decisions should be individualized and other risk factors should be considered. This recommendation was based on a meta-analysis with almost 5 million healthy subjects where they found that for an eGFR > 90 ml/min/1.73 m2, the life-long risk of developing CKD was approximately 1% of any age and race. For subjects aged 60 years or older with an eGFR between 60 and 89 ml/min/1.73 m2, the risk is less than 1%
Reference
Gustavo Laham*, Juan Pablo Ponti and Gervasio Soler Pujol. Assessing Renal Function for Kidney Donation. How Low Is Too Low?. Frontiers in Medicine | http://www.frontiersin.org
Many thanks Dr Y Saini, Dr Heba and Dr F Batista,
Let us move to week 4.
Ajay
BTS Guidelines suggests the safe threshold level of kidney function to donate as follows:
Potential donors should be evaluated initially using estimated glomerular filtration rate (eGFR), using most widely accepted CKD-EPI formula.
Then for a more detailed assessment GFR must be further assessed by measured GFR method (mGFR) such as clearance of 51Cr-EDTA, 125iothalamate or iohexol.
A safe threshold level of kidney function during pre-donation period is considered when it leaves sufficient function after donation so that donor health remains normal without affecting donor’s lifespan.
The threshold for donation is normotensive, non-diabetic, non-albuminuric individual with GFR > 80ml/min/1.73sqm as per BTS guidelines.
whereas as per KDOQI following are the guidelines for safe threshold for donation:
The safe threshold is the predonation kidney function that maintain the donor in normal health without affecting life span and keep the donor with normal age related kidney function after donation.
Recommended threshold levels are presented in the table.
KDIGO guidelines recommend accepting the donor if GFR</=90 and eclusion if GFR<60 and for those with GFR ranging from 60 to 90, assessment of risk of renal impairment versus program’s pre-established risk threshold and if the post donation risk is higher than the program’s acceptable threshold, the donor is declined.
BTS/RA Living Donor Kidney Transplantation Guidelines 2018
Mandelbrot DA, Reese PP, Garg N, Thomas CP, Rodrigue JR, Schinstock C, Doshi M, Cooper M, Friedewald J, Naik AS, Kaul DR. KDOQI US commentary on the 2017 KDIGO clinical practice guideline on the evaluation and care of living kidney donors. American Journal of Kidney Diseases. 2020 Mar 1;75(3):299-316.
Age (years) Measured GFR (mL/min/1.73m2)
Male Female
20-29 100 (74-126) 98 (72-125)
30-34 100 (74-126) 98 (72-125)
35 99 (73-126) 98 (72-125)
40 96 (70-122) 94 (68-121)
45 93 (67-119) 91 (64-117)
50 90 (63-116) 87 (60-113)
55 86 (60-112) 83 (56-109)
60 83 (57-109) 79 (52-105)
65 80 (54-106) 75 (48-101)
70 76 (50-102) 71 (44-97)
75 73 (47-99) 67 (40-94)
80 70 (44-96) 63 (36-90)
What is a safe threshold level of kidney function for donation on to donate?very small risk of 80 ml/min/1.7m2 where the mean age at donation was around 40 -50 years so threshold eGFR .80 ml/min////1.7m2 is safe in 35 years and above range but those with additional risk factor threashold >90.
for those above 60 y male should >70 eGFR.
those 65 y male eGFR should be .71eGFR.
those 70 yrs male eGFR .67eGFR.
those 80 yrs male eGFR 58
BTS/guidelines kidney transplantation. for donation
Based on BTS LDKT Guidelines 4th edition consultation draft, December 2017:
Initial evaluation of donor candidates should be using estimated glomerular filtration rate (eGFR), expressed as mL/min/1.73m2 computed from a creatinine assay standardised to the International Reference Standard. (B1)
GFR must subsequently be assessed by a reference measured method (mGFR) such as clearance of 51Cr-EDTA, 125iothalamate or Iohexol performed according to guidelines published by the British Society of Nuclear Medicine. (B1)
A safe threshold level of pre-donation kidney function is one that leaves sufficient function after donation to maintain the donor in normal health (or minimal absolute reduction of health) without affecting lifespan.
The following table shows Advisory Threshold Measured GFR Considered Safe for Donation:
The safe threshold level of kidney function to donate if GFR more than 80ml/min/1.73m2.BTC guideline recommended donation according estimate GFR in respect of age
GFR> 90 between age 18-30
GFR> 85 ml/min/1.73m2 between age 30- 40 y
GFR>80 ml/min/1.73m2 between age 41- 65 y
GFR>75 ml/min/1.73m2 at age > 65 years
Advisory GFR Thresholds for Donation
Pre-donation mGFR should be such that the predicted post-donation GFR remains within the gender and age-specific normal range within the donor’s lifetime. Recommended threshold levels are defined in Table 5.5.2. (B1)
Again The risk of end-stage renal disease (ESRD) after donation is no higher than that of the general population. However, there is a very small absolute increased lifetime risk of ESRD following donation for which the potential donor must be consented.
reference
BTS/RA Living Donor Kidney Transplantation Guidelines 2018
-A safe threshold level of pre-donation kidney function is one that leaves sufficient function after donation to maintain the donor in normal health (or minimal absolute reduction of health) without affecting lifespan. This requires a definition of normal renal function and of the normal range of age-related change in renal function in
healthy adults over time.
-GFR of 90 mL/min per 1.73 m2 or greater should be considered an acceptable level of kidney function for donation.
– The decision to approve donor candidates with GFR 60 to 89 mL/min per 1.73 m2 should be individualized based on demographic and health profile in relation to the transplant program’s acceptable risk threshold.
– Donor candidates with GFR less than 60 mL/min per
1.73 m2 should not donate.
Age and Gender-Specific GFR based on almost 3000 Healthy
Potential UK living kidney donors
Age (years) Measured GFR (mL/min/1.73m2)
Male Female
20-29 100 (74-126) 98 (72-125)
30-34 100 (74-126) 98 (72-125)
35 99 (73-126) 98 (72-125)
40 96 (70-122) 94 (68-121)
45 93 (67-119) 91 (64-117)
50 90 (63-116) 87 (60-113)
55 86 (60-112) 83 (56-109)
60 83 (57-109) 79 (52-105)
65 80 (54-106) 75 (48-101)
70 76 (50-102) 71 (44-97)
75 73 (47-99) 67 (40-94)
80 70 (44-96) 63 (36-90)
Referrences:
-KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors August 2017 . Volume 101 . Number 8S-1.
-BTS/RA Living Donor Kidney Transplantation Guidelines 2018