Assessment of the impact of nephrectomy on cardiovascular risk in living kidney donors: longitudinal follow-up. Focus on endothelial dysfunction, inflammation and oxidative stress.

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The aim of this study is to assess the impact of nephrectomy on cardiovascular risk factors and vascular function, with emphasis on early markers of vasuclar disease including endothelial dysfunction, oxidative stress and inflammation. The follow-up studies of donor safety are flawed by being retrospective and with significant loss to follow-up. The numbers of patients who have died or have significant cardiovascular disease have not been adequately assessed. In the general population any degree of renal impairment, eGFR < 60mls/min (Glomerular filtration rate) is independently associated with an increase in cardiovascular risk, death and hospitalization. Retrospective analysis or our cohort of live donors over the last 15 years (up till 2005) revealed that 39% of respondents had stage 2 (eGFR 15 -30mls/min) chronic kidney disease. We hypothesize that donors, post nephrectomy with the associated decrement in GFR may be at increased risk of future vascular disease. Specifically, we will scrutinize the following features of early vascular disease: Inflammation: hsC-reactive protein, IL-6 Endothelial dysfunction: Brachial Artery Reactivity ) Smooth muscle dysfunction: Pulse Wave Velocity Oxidative stress:Plasma, urinary 8-iso-prostaglandin 2 and oxidized LDL Vascular structure: Carotid intima-media thickness We will also collect data relevant to features of metabolic syndrome including triglyceride, High Density Lipoprotein, waist-hip ratio and fasting glucose, to determine the association between renal and cardiac function and traditional cardiovascular risk factors. This is a 5 year longituidinal study of live donors. All patients will be reviewed in outpatient clinic every 12 months. Data on vascular imaging studies will be collected at baseline and annually. Glomerular filtration rate will be estimated at baseline and annually using 24 hour urine collection, MDRD and 51Cr-EDTA nuclear scan. 24 hour urine collection will be used to measure urinary protein and albumin excretion. All cardiovascular events, admissions, biochemical and clinical data will be recorded at specific annually at time of follow up. A control group (already established within the CCRE), matched for age and gender will be approached for comparative purposes.

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