Chronic kidney disease affects 10-15% of the global population and can progress to end-stage kidney disease, requiring dialysis or a kidney transplant. Kidney transplantation, particularly with a kidney from a living donor, offers better survival rates and a higher quality of life compared to dialysis. Although living kidney donation is generally safe, studies indicate that donors have an increased risk of developing end-stage kidney disease and higher mortality rates compared to healthy non-donors. Therefore, potential donors undergo a rigorous screening process before donation, in which obesity (BMI ≥35 kg/m²) is often an exclusion criterion. Since BMI is an inaccurate measure of body composition, further research is needed into alternative assessment methods to better evaluate risks and provide optimal care for donors.
This dissertation by Lisa Beatrijs Westenberg examines the impact of pre-donation body composition on the outcomes of living kidney donation for the donor. It consists of two parts. The first part addresses conventional body composition measures currently used in living kidney donation guidelines and their association with adverse donation outcomes. The second part explores new techniques for measuring body composition and highlights the importance of precise assessments, not only for kidney donors but also for broader applications.
Key findings include that higher BMI values and central fat distribution before donation were associated with lower kidney function after living kidney donation. Body composition analysis using CT scans showed that a greater amount of abdominal fat on CT images was associated with lower kidney function before and shortly after donation. Moreover, both higher muscle mass and better muscle quality appear to be positively associated with higher kidney function.
This dissertation emphasizes the importance of accurately assessing donor body composition during the screening process for living kidney donation to estimate (long-term) risks as precisely as possible and potentially improve body composition before donation to optimize living kidney donation outcomes.
