{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T02:41:32Z","timestamp":1790217692621,"version":"4.1.0"},"reference-count":57,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>\n                      Unilateral nephrectomy for kidney donation results in loss of about 30% of baseline GFR, leaving some donors with GFR &lt;60 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      , the threshold for the diagnosis CKD. This has resulted in insurability problems for some donors. This article reviews the definition of CKD, risks associated with CKD, and large follow-up studies on the vital status and risk of ESRD in kidney donors. It also provides evidence that kidney donors, despite having reduced GFR, are not at increased risk for CKD-associated morbidity and mortality. Epidemiologic studies, most with follow-up &lt;10 years, have shown an association between GFR &lt;60 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      and higher mortality and progression to ESRD. Low GFR in the absence of any other markers for kidney disease, however, conveys attenuated or minimal risk. Of note, studies of long-term kidney donor outcomes (6\u201345 years) have not shown excess mortality or ESRD. The limitation of the collective evidence is that the increased risks associated with GFR &lt;60 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      were demonstrated in much larger cohorts than those reported for kidney donor outcomes, but donor outcome studies have substantially longer follow-up. On the basis of current findings, kidney donors with low GFR and no other signs of kidney disease should not be classified as having CKD. This is definitely not the reward they deserve, and, more important, the implications of reduced GFR in donors are not associated with unfavorable outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.02110213","type":"journal-article","created":{"date-parts":[[2013,6,29]],"date-time":"2013-06-29T04:09:31Z","timestamp":1372478971000},"page":"1406-1413","source":"Crossref","is-referenced-by-count":41,"title":["The Unjustified Classification of Kidney Donors as Patients with CKD"],"prefix":"10.2215","volume":"8","author":[{"given":"Arthur J.","family":"Matas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan N.","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-19-20230811","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1056\/NEJM199912023412303","article-title":"Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.","volume":"341","author":"Wolfe","year":"1999","journal-title":"N Engl J Med"},{"key":"R2-19-20230811","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1056\/NEJM198502283120905","article-title":"The quality of life of patients with end-stage renal disease.","volume":"312","author":"Evans","year":"1985","journal-title":"N Engl J Med"},{"key":"R3-19-20230811","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1097\/00007890-199508270-00003","article-title":"Evaluation of living renal donors. The current practice of US transplant centers.","volume":"60","author":"Bia","year":"1995","journal-title":"Transplantation"},{"key":"R4-19-20230811","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1046\/j.1038-5282.2001.00400.x-i1","article-title":"Morbidity and mortality after living kidney donation, 1999-2001: Survey of United States transplant centers.","volume":"3","author":"Matas","year":"2003","journal-title":"Am J Transplant"},{"key":"R5-19-20230811","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1001\/jama.2010.237","article-title":"Perioperative mortality and long-term survival following live kidney donation.","volume":"303","author":"Segev","year":"2010","journal-title":"JAMA"},{"key":"R6-19-20230811","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/0140-6736(92)92683-7","article-title":"20 years or more of follow-up of living kidney donors.","volume":"340","author":"Najarian","year":"1992","journal-title":"Lancet"},{"key":"R7-19-20230811","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1038\/ki.1995.355","article-title":"Long-term effects of reduced renal mass in humans.","volume":"48","author":"Kasiske","year":"1995","journal-title":"Kidney Int"},{"key":"R8-19-20230811","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1097\/00007890-199710150-00007","article-title":"Kidney donors live longer.","volume":"64","author":"Fehrman-Ekholm","year":"1997","journal-title":"Transplantation"},{"key":"R9-19-20230811","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1097\/00007890-200108150-00015","article-title":"No evidence of accelerated loss of kidney function in living kidney donors: results from a cross-sectional follow-up.","volume":"72","author":"Fehrman-Ekholm","year":"2001","journal-title":"Transplantation"},{"key":"R10-19-20230811","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1097\/01.tp.0000250728.73268.e3","article-title":"Incidence of end-stage renal disease among live kidney donors.","volume":"82","author":"Fehrman-Ekholm","year":"2006","journal-title":"Transplantation"},{"key":"R11-19-20230811","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1056\/NEJMoa0804883","article-title":"Long-term consequences of kidney donation.","volume":"360","author":"Ibrahim","year":"2009","journal-title":"N Engl J Med"},{"key":"R12-19-20230811","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1097\/TP.0b013e318192dc95","article-title":"Short- and long-term donor outcomes after kidney donation: Analysis of 601 cases over a 35-year period at Japanese single center.","volume":"87","author":"Okamoto","year":"2009","journal-title":"Transplantation"},{"key":"R13-19-20230811","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1093\/ndt\/gfr303","article-title":"Overall and cardiovascular mortality in Norwegian kidney donors compared to the background population.","volume":"27","author":"Mj\u00f8en","year":"2012","journal-title":"Nephrol Dial Transplant"},{"key":"R14-19-20230811","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/j.1432-2277.2012.01439.x","article-title":"Very long-term follow-up of living kidney donors.","volume":"25","author":"Fournier","year":"2012","journal-title":"Transpl Int"},{"key":"R15-19-20230811","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1053\/j.ackd.2012.04.006","article-title":"Psychosocial and socioeconomic issues facing the living kidney donor.","volume":"19","author":"Dew","year":"2012","journal-title":"Adv Chronic Kidney Dis"},{"key":"R17-19-20230811","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1111\/j.1600-6143.2007.01793.x","article-title":"Insurability of living organ donors: A systematic review.","volume":"7","author":"Yang","year":"2007","journal-title":"Am J Transplant"},{"key":"R19-19-20230811","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1016\/S0140-6736(10)60674-5","article-title":"Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: A collaborative meta-analysis.","volume":"375","author":"Matsushita","year":"2010","journal-title":"Lancet"},{"key":"R20-19-20230811","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1038\/ki.2010.531","article-title":"Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts.","volume":"80","author":"Gansevoort","year":"2011","journal-title":"Kidney Int"},{"key":"R21-19-20230811","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1038\/ki.2010.550","article-title":"Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts.","volume":"79","author":"Astor","year":"2011","journal-title":"Kidney Int"},{"key":"R23-19-20230811","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1111\/j.1523-1755.2005.00365.x","article-title":"Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO).","volume":"67","author":"Levey","year":"2005","journal-title":"Kidney Int"},{"key":"R24-19-20230811","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1038\/ki.2010.483","article-title":"The definition, classification, and prognosis of chronic kidney disease: A KDIGO Controversies Conference report.","volume":"80","author":"Levey","year":"2011","journal-title":"Kidney Int"},{"key":"R26-19-20230811","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.2215\/CJN.00960208","article-title":"Screening for CKD with eGFR: Doubts and dangers.","volume":"3","author":"Glassock","year":"2008","journal-title":"Clin J Am Soc Nephrol"},{"key":"R27-19-20230811","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1681\/ASN.2005090986","article-title":"Mortality risk stratification in chronic kidney disease: One size for all ages?","volume":"17","author":"O\u2019Hare","year":"2006","journal-title":"J Am Soc Nephrol"},{"key":"R28-19-20230811","doi-asserted-by":"crossref","first-page":"570","DOI":"10.7326\/0003-4819-156-8-201204170-00008","article-title":"Screening for, monitoring, and treatment of chronic kidney disease stages 1 to 3: A systematic review for the U.S. Preventive Services Task Force and for an American College of Physicians Clinical Practice Guideline.","volume":"156","author":"Fink","year":"2012","journal-title":"Ann Intern Med"},{"key":"R29-19-20230811","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1681\/ASN.2008010110","article-title":"Staging of chronic kidney disease: Time for a course correction.","volume":"19","author":"Bauer","year":"2008","journal-title":"J Am Soc Nephrol"},{"key":"R30-19-20230811","doi-asserted-by":"crossref","first-page":"12","DOI":"10.7326\/0003-4819-154-1-201101040-00003","article-title":"Using proteinuria and estimated glomerular filtration rate to classify risk in patients with chronic kidney disease: A cohort study.","volume":"154","author":"Tonelli","year":"2011","journal-title":"Ann Intern Med"},{"key":"R31-19-20230811","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1038\/ki.2011.61","article-title":"Strengths and weaknesses of renal markers as risk factors and surrogate markers.","volume":"79","author":"Johnson","year":"2011","journal-title":"Kidney Int"},{"key":"R32-19-20230811","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/j.1600-6143.2009.02562.x","article-title":"Primum non Nocere: Is chronic kidney disease staging appropriate in living kidney transplant donors?","volume":"9","author":"Barri","year":"2009","journal-title":"Am J Transplant"},{"key":"R33-19-20230811","doi-asserted-by":"crossref","first-page":"e1167","DOI":"10.1136\/bmj.e1167","article-title":"Does reduced glomerular filtration rate equate to chronic kidney disease?","volume":"344","author":"White","year":"2012","journal-title":"BMJ"},{"key":"R34-19-20230811","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1038\/sj.ki.5002374","article-title":"Age- and gender-specific reference values of estimated GFR in Caucasians: The Nijmegen Biomedical Study.","volume":"72","author":"Wetzels","year":"2007","journal-title":"Kidney Int"},{"key":"R35-19-20230811","doi-asserted-by":"crossref","first-page":"3851","DOI":"10.1093\/ndt\/gfn356","article-title":"Cardiovascular and renal outcome in subjects with K\/DOQI stage 1-3 chronic kidney disease: The importance of urinary albumin excretion.","volume":"23","author":"Brantsma","year":"2008","journal-title":"Nephrol Dial Transplant"},{"key":"R36-19-20230811","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1001\/jama.2011.468","article-title":"Detection of chronic kidney disease with creatinine, cystatin C, and urine albumin-to-creatinine ratio and association with progression to end-stage renal disease and mortality.","volume":"305","author":"Peralta","year":"2011","journal-title":"JAMA"},{"key":"R37-19-20230811","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/S0272-6386(12)80032-1","article-title":"Renal function up to 50 years after unilateral nephrectomy in childhood.","volume":"21","author":"Baudoin","year":"1993","journal-title":"Am J Kidney Dis"},{"key":"R38-19-20230811","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1038\/ki.1993.156","article-title":"Forty-five year follow-up after uninephrectomy.","volume":"43","author":"Narkun-Burgess","year":"1993","journal-title":"Kidney Int"},{"key":"R39-19-20230811","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1053\/j.ackd.2012.04.010","article-title":"Living donor practices in the United States.","volume":"19","author":"Mandelbrot","year":"2012","journal-title":"Adv Chronic Kidney Dis"},{"key":"R40-19-20230811","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1093\/ndt\/gfr161","article-title":"Post-nephrectomy development of renal function in living kidney donors: A cross-sectional retrospective study.","volume":"26","author":"Fehrman-Ekholm","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"R41-19-20230811","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1038\/sj.ki.5001819","article-title":"Proteinuria and reduced kidney function in living kidney donors: A systematic review, meta-analysis, and meta-regression.","volume":"70","author":"Garg","year":"2006","journal-title":"Kidney Int"},{"key":"R42-19-20230811","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1097\/TP.0b013e3181e64237","article-title":"Definition of chronic kidney disease after uninephrectomy in living donors: What are the implications?","volume":"90","author":"Barri","year":"2010","journal-title":"Transplantation"},{"key":"R43-19-20230811","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1038\/sj.ki.5002252","article-title":"Reduced kidney function in living kidney donors.","volume":"71","author":"Wan","year":"2007","journal-title":"Kidney Int"},{"key":"R44-19-20230811","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1007\/s10157-010-0279-y","article-title":"Very low but stable glomerular filtration rate after living kidney donation: Is the concept of \u201cchronic kidney disease\u201d applicable to kidney donors?","volume":"14","author":"Kido","year":"2010","journal-title":"Clin Exp Nephrol"},{"key":"R45-19-20230811","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.2215\/CJN.08761209","article-title":"Renal function equations before and after living kidney donation: A within-individual comparison of performance at different levels of renal function.","volume":"5","author":"Tent","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"key":"R46-19-20230811","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1111\/j.1440-1797.2007.00852.x","article-title":"Risk factors for MDRD-GFR of less than 60 mL\/min per 1.73 m2 in former kidney donors.","volume":"12","author":"Lee","year":"2007","journal-title":"Nephrology (Carlton"},{"key":"R47-19-20230811","doi-asserted-by":"crossref","first-page":"e1203","DOI":"10.1136\/bmj.e1203","article-title":"Cardiovascular disease in kidney donors: matched cohort study.","volume":"344","author":"Garg","year":"2012","journal-title":"BMJ"},{"key":"R48-19-20230811","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1111\/j.1600-6143.2011.03609.x","article-title":"Ethnic and gender related differences in the risk of end-stage renal disease after living kidney donation.","volume":"11","author":"Cherikh","year":"2011","journal-title":"Am J Transplant"},{"key":"R49-19-20230811","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1056\/NEJMoa1000950","article-title":"Racial variation in medical outcomes among living kidney donors.","volume":"363","author":"Lentine","year":"2010","journal-title":"N Engl J Med"},{"key":"R50-19-20230811","doi-asserted-by":"crossref","first-page":"2561","DOI":"10.1111\/j.1600-6143.2011.03816.x","article-title":"Living kidney donor follow-up: State-of-the-art and future directions, conference summary and recommendations.","volume":"11","author":"Leichtman","year":"2011","journal-title":"Am J Transplant"},{"key":"R51-19-20230811","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1111\/j.1600-6143.2010.03023.x","article-title":"\u2018Normal for now\u2019 or \u2018at future risk\u2019: A double standard for selecting young and older living kidney donors.","volume":"10","author":"Steiner","year":"2010","journal-title":"Am J Transplant"},{"key":"R52-19-20230811","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1097\/01.TP.0000128168.97735.B3","article-title":"Blood pressure and renal function after kidney donation from hypertensive living donors.","volume":"78","author":"Textor","year":"2004","journal-title":"Transplantation"},{"key":"R53-19-20230811","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1097\/TP.0b013e318240e9b9","article-title":"Effects of preexistent hypertension on blood pressure and residual renal function after donor nephrectomy.","volume":"93","author":"Tent","year":"2012","journal-title":"Transplantation"},{"key":"R54-19-20230811","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1111\/j.1600-6143.2009.02944.x","article-title":"Diabetes after kidney donation.","volume":"10","author":"Ibrahim","year":"2010","journal-title":"Am J Transplant"},{"key":"R55-19-20230811","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1111\/j.1600-6143.2008.02427.x","article-title":"Pregnancy and birth after kidney donation: the Norwegian experience.","volume":"9","author":"Reisaeter","year":"2009","journal-title":"Am J Transplant"},{"key":"R56-19-20230811","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1111\/j.1600-6143.2009.02548.x","article-title":"Pregnancy outcomes after kidney donation.","volume":"9","author":"Ibrahim","year":"2009","journal-title":"Am J Transplant"},{"key":"R57-19-20230811","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1053\/j.ajkd.2011.09.019","article-title":"Bone and mineral metabolism and fibroblast growth factor 23 levels after kidney donation.","volume":"59","author":"Young","year":"2012","journal-title":"Am J Kidney Dis"},{"key":"R58-19-20230811","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1053\/j.ajkd.2012.01.013","article-title":"Fracture risk in living kidney donors: A matched cohort study.","volume":"59","author":"Garg","year":"2012","journal-title":"Am J Kidney Dis"},{"key":"R59-19-20230811","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/j.1600-6143.2012.04303.x","article-title":"Medical outcomes in African American live kidney donors: A matched cohort study.","volume":"13","author":"Doshi","year":"2013","journal-title":"Am J Transplant"},{"key":"R60-19-20230811","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1097\/TP.0b013e3181e6e79b","article-title":"Long-term medical outcomes among Aboriginal living kidney donors.","volume":"90","author":"Storsley","year":"2010","journal-title":"Transplantation"},{"key":"R61-19-20230811","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1016\/j.transproceed.2008.03.104","article-title":"Age, gender, race, and associations with kidney failure following living kidney donation.","volume":"40","author":"Gibney","year":"2008","journal-title":"Transplant Proc"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201308000-00019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:43:29Z","timestamp":1786369409000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201308000-00019"}},"subtitle":["Critique and Recommendations"],"short-title":[],"issued":{"date-parts":[[2013,8]]},"references-count":57,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2013]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.02110213","relation":{},"ISSN":["1555-9041"],"issn-type":[{"value":"1555-9041","type":"print"}],"subject":[],"published":{"date-parts":[[2013,8]]}}}