Does reduced glomerular filtration rate equate to chronic kidney disease?

An estimated 32 201 living donor kidney transplants were performed worldwide in 2010.1 This number will undoubtedly increase in coming years as demand for kidney transplantation grows and strategies to meet this demand, such as paired kidney exchange, gather momentum. Although living kidney donors have mortality outcomes and quality of life scores above population norms,2 3 donor nephrectomy will always entail some degree of medical, social, financial, or psychological risk to the donor, and the transplantation community and the public must be satisfied that any risks are explicit and minimal.

The linked research paper by Garg and colleagues (doi:10.1136/bmj.e1113) makes an important contribution to our understanding of the long term consequences of living kidney donation.4 In patients with chronic kidney disease, there is an established association between reduced kidney function and cardiovascular events. Although donor uninephrectomy also results in a sizable decrease in glomerular filtration rate (GFR), evidence of an association between reduced GFR and cardiovascular events in living kidney donors is limited.5 6 Long term data on outcomes for donors have been scarce,3 and the identification of appropriate control groups against which to compare rigorously selected, highly screened living kidney donors …