Long-term Follow-up of Living Kidney Donors With Chronic Kidney Disease at 1 Year After Nephrectomy.

BACKGROUND: Although renal function recovery of living kidney donors has been reported in a number of studies, many patients show poor recovery, and the long-term prognosis of these patients has not been well studied. In this investigation we explored the long-term prognosis of renal function in patients with chronic kidney disease (CKD) at 1 year after nephrectomy. METHODS: Patients who underwent donor nephrectomy during the period from March 2006 to April 2014, with a follow-up creatinine study at 1 year postoperatively and more than 3 years of follow-up, were included in the study. Creatinine and estimated glomerular filtration rate (eGFR, using the Modification of Diet in Renal Disease formula) before and after surgery were studied. Age, sex, history of hypertension or diabetes, body mass index, blood pressure, complete blood count, preoperative routine serum chemistry, and urine study results were reviewed. RESULTS: Among 841 patients who had donor nephrectomy, 362 were included in the study. There were 111 patients (30.6%) with eGFR <60 mL/min/1.73 m2 at 1 year postsurgery, and the median follow-up period was 62.8 months (interquartile range [IQR] 42.0-86.3 months). The maximum eGFR after 3-year follow-up was studied, and 48 patients (43.2%) never recovered eGFR to >60 mL/min/1.73 m2. Age, history of hypertension, preoperative eGFR, and eGFR at 1 year were predictive factors at univariate analysis. Multivariate analysis of these factors was studied, and age (52.5 [IQR 47-55.7] vs 47 [IQR 7-53] years, odds ratio [OR] 1.1, 95% confidence interval [CI] 1.02-1.15, P = .007), history of hypertension (16.7% vs 1.6%, OR 10.0, 95% CI 1.09-92.49, P = .042), and eGFR at 1 year (53.9 [IQR 50.3-56.0] vs 57.0 [IQR 54.2-58.4] mL/min/1.73 m2, OR 0.8, 95% CI 0.72-0.92, P = .002) remained as significant risk factors. CONCLUSION: Of all living donors, 15.7% had CKD after >3 years of follow-up. Close observation is warranted when donors have CKD after 1 year follow-up, as 43.2% fail to recover renal function. Patients who are older, have a history of hypertension, and have low eGFR at 1-year follow-up are especially at risk.

Delayed Recovery of Renal Function After Donor Nephrectomy.

BACKGROUND: Many living kidney donors are still at risk of chronic kidney disease (CKD) 1 year after nephrectomy. Although some donors still experience poor renal function, many exhibit delayed recovery of renal function afterwards. We studied the factors related to delayed recovery of renal function in patients with CKD at 1 year after nephrectomy. METHODS: Patients who underwent donor nephrectomy from March 2006 to April 2014 with a follow-up creatinine study at 1 month, 6 months, 1 year, and after 3 years of follow-up were included in the study. Age, sex, history of hypertension or diabetes, body mass index, blood pressure, complete blood cell count, preoperative routine serum chemistry, and urine study results were reviewed. RESULTS: Among 275 donors, 83 (30.2%) who had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 at 1 year of follow-up were included in the study, and the eGFR was observed during a median follow-up of 62.0 months (interquartile range [IQR], 48.9-83.1 months). Those who had improvements in eGFR of >5 mL/min/1.73 m2 were included in the recovery group (n = 48 [57.8%]), and those who did not were included in the nonrecovery group (n = 35 [42.2%]). The preoperative and 1-year follow-up eGFR did not differ significantly between the 2 groups, and the maximum eGFR after 3 years was higher in the recovery group (68.68 mL/min/1.73 m2 [IQR, 61.81-75.64 mL/min/1.73 m2] vs 55.63 mL/min/1.73 m2 [IQR, 51.73-58.29 mL/min/1.73 m2]; P < .001). The recovery group was more likely to have a history of hypertension (4.2% vs 20%; P = .032), a lower body mass index (24.11 kg/m2 [IQR, 22.04-25.20 kg/m2] vs 25.25 kg/m2 [IQR, 23.23-26.44 kg/m2]; P = .01), and a lower preoperative uric acid level (4.7 mg/dL [IQR, 3.8-5.4 mg/dL] vs 5.3 mg/dL [IQR, 4.4-6.2 mg/dL]; P = .031). After multivariate logistic regression analysis, history of hypertension (odds ratio, 0.131; P = .022) and uric acid level (odds ratio, 0.641; P = .036,) remained as significant factors. CONCLUSIONS: Although 30.2% of donors had CKD at 1 year after nephrectomy, 57.8% reported improved renal function. Those with a history of hypertension and high preoperative uric acid levels were less likely to have improvements in renal function and required close follow-up.

Impact of Cigarette Smoking on Living Kidney Donors.

BACKGROUND: Smoking is known to result in a decline in renal allograft function and survival of recipients; however, the effect of smoking on living kidney donors remains unknown. In this study we evaluated the impact of cigarette smoking on renal function of kidney donors. METHODS: Among 1056 donors who underwent nephrectomy, 612 completed the 6-month follow-up protocol and were enrolled in the study. The association of smoking status, including pack-years smoking history, and postoperative renal function was evaluated. RESULTS: Among donors, 68.1% had never smoked, 8% were former smokers, and 23.9% were current smokers. Donors who never smoked were older than former and current smokers (42.3 ± 11.8, 41.9 ± 11.1, and 38.3 ± 10.9 years, respectively; P < .001). There was no difference in preoperative renal function between groups; however, postoperative estimated glomerular filtration rate (eGFR) was lower in former and current smokers than in those who never smoked (64.6 ± 13.8, 64.7 ± 12.3, and 67.8 ± 13.1 mL/min/1.73 m2, respectively; P = .023). In former and current smokers, pack-years smoking history was negatively associated with pre- and postoperative eGFR (r = -0.305 and -0.435, P < .001), and correlated with postoperative percent eGFR decline (r = 0.248, P < .001). Smoking history was associated with postoperative development of chronic kidney disease (CKD). Especially in former smokers, a smoking history of more than 12 pack-years was strongly associated with development of CKD (odds ratio = 7.5, P = .003). CONCLUSION: Even if they no longer smoke, donors with a smoking history require close observation due to increased risk of CKD development after kidney donation. A detailed pack-years smoking history should be obtained, and smoking cessation strategies should be implemented in kidney donors.

Various levels and forms of dietary α-lipoic acid in broiler chickens: Impact on blood biochemistry, stress response, liver enzymes, and antibody titers.

The present experiment was conducted to evaluate the impact of various levels and forms of α-lipoic acid (ALA) on blood biochemistry, immune and stress response, and antibody titers in broiler chickens. The four levels (7.5, 15, 75, and 150 ppm) and 2 sources (powder, P-ALA and encapsulated, E-ALA) of ALA along with negative (C-) and positive control (C+; contains antibiotics) diets consisted of 10 dietary treatments, and these treatments were allocated to 1,200 1-d-old chicks and were replicated 12 times with 10 birds per replicate. Among the blood biochemistry parameters, creatinine levels were almost 3 times lower in E-ALA-supplemented diets compared to the C- diet (0.09 vs. 0.25 mg/dL; P<0.0001). Neither level nor source of ALA affected blood urea nitrogen (BUN), total protein (TP), albumin, globulin, or albumin to globulin ratio (AGR). The supplemented diets decreased serum levels of the liver enzymes aspartate-aminotransferase (AST; P<0.006) and alanine-aminotransferase (ALT; P<0.0003). The Newcastle disease virus (NDV) antibody response in supplemented groups was poor at day zero (P<0.0001) but increased by d 14 (P<0.03). Birds did not respond to infectious bronchitis virus (IBV) vaccination at any observed stage (P>0.05). The concentration of cortisol was reduced in chickens fed ALA-supplemented diets as compared to the C- diet (P<0.001). Results suggest that ALA-supplemented diets ameliorated blood biochemistry profiles and immune responses and reduced stress in broiler chickens. The encapsulated form of ALA was more effective than the powder form.

Influence of monochromatic light on quality traits, nutritional, fatty acid, and amino acid profiles of broiler chicken meat.

The role of monochromatic lights was investigated on meat quality in 1-d-old straight-run broiler chicks (n = 360), divided into 6 light sources with 6 replicates having 10 chicks in each replicate. Six light sources were described as incandescent bulbs (IBL, as a control) and light-emitting diode (LED) light colors as white light (WL), blue light, red light (RL), green light, and yellow light. Among LED groups, the RL increased the concentration of monounsaturated fatty acids (P < 0.001), saturated fatty acids (P < 0.001), and the saturated:polyunsaturated fatty acid ratio (P < 0.001), but reduced the concentration of polyunsaturated fatty acid, n-3 fatty acid, and n-6 fatty acid. The IBL increased the n-3 and sulfur-containing amino acids but reduced the n-6:n-3 nonessential amino acids. The WL improved the concentration of most of the essential amino acids (P < 0.01) and nonessential amino acids (P < 0.01) of breast meat. It can be extracted that the light produced by LED responded similar to the IBL light in influencing nutrient contents of meat. Moreover, LED is not decisive in improving fatty acid composition of meat. However, the role of IBL in reducing n-6:n-3 ratio and enhancing n-3 cannot be neglected. Among LED, WL is helpful in improving essential and nonessential amino acid contents of broiler meat.

Supplementation of direct-fed microbials as an alternative to antibiotic on growth performance, immune response, cecal microbial population, and ileal morphology of broiler chickens.

An experiment was conducted to investigate the supplementation of direct-fed microbials (DFM) as an alternative to antibiotics on growth performance, immune response, cecal microbial population, and ileal morphology of broiler chickens. A total of 800 one-day-old male broiler chicks (Ross × Ross) were randomly allotted to 4 dietary treatments with 4 replicate pens per treatment (50 birds/replicate pen). The 4 dietary treatments fed for 35 d were a corn-soybean meal basal diet (control); control plus 0.1% virginiamycin, as an antibiotic growth promoter (AGP); control plus 0.1% direct-fed microbials that contained Lactobacillus reuteri (DFM 1); and control plus 0.1% direct-fed microbials that contained a mixture of L. reuteri, Bacillus subtilis, and Saccharomyces cerevisiae (DFM 2). Results showed that dietary AGP and DFM supplementation significantly increased (P < 0.05) the BW gain of broilers during 0 to 21 d. The feed intake was reduced, whereas the feed conversion was improved significantly when birds were fed DFM 2 at 0 to 7 d of age. The white blood cell and monocyte levels were significantly higher in the DFM 2 group compared with the control. In addition, feeding DFM significantly (P < 0.05) increased the plasma immunoglobulin levels where a higher level was observed in DFM 2 compared with those of the other treatments. Neither DFM nor AGP treatments affected the cecal Lactobacillus and Salmonella content; however, cecal Escherichia coli content significantly decreased in broiler chickens fed DFM and AGP. The ileal villus height, and width and total thickness of muscularis externa were significantly increased when birds were fed DFM compared with AGP and control. These results indicate that the dietary supplementation of DFM increases the growth performance of birds at an early age, stimulates the immune response, decreases the number of E. coli, and improves the ileal morphology of broiler chickens. Thus, DFM that contained a mixture of several beneficial microorganisms could be a viable alternative to antibiotics in the broiler diets.

Growth performance and hematological traits of broiler chickens reared under assorted monochromatic light sources.

A study was conducted to investigate the effect of different monochromatic lights on growth performance and hematological response of growing broiler chickens. A total of 360 one-day-old broiler chicks were randomly divided into 6 lighting treatments, which were replicated 6 times with 10 chicks in each replicate. Six light treatments include incandescent bulbs (as a control) and light-emitting diode white light, blue light, red light, green light, and yellow light (YL). The birds were provided with similar nutritional specifications and environmental management facilities, except for the lights throughout the experimental period. Growth performance was evaluated in terms of BW, BW gain, feed intake, and feed conversion ratio at weekly intervals. At the end of 5 wk, 2 birds from each replicate were randomly selected for blood collection to determine hematological response. The BW and feed intake was numerically higher in YL at 5 wk of age. But interestingly, this did not result in improved feed conversion ratio in YL; nevertheless, numerical values were lower in YL at 5 wk (P > 0.05). Red blood cells, blood platelet count, and percent hematocrit were numerically higher under YL, whereas white blood cell counts and percent hemoglobin remained unaffected due to light treatments. It was concluded that monochromatic light is a potential light source that might provide a beneficial effect on growth performance but is inconclusive for hematological measures of broilers.

Effect of heating system using a geothermal heat pump on the production performance and housing environment of broiler chickens.

A geothermal heat pump (GHP) is a potential heat source for the economic heating of broiler houses with optimum production performance. An investigation was conducted to evaluate the effect of a heating system using a GHP on production performance and housing environment of broiler chickens. A comparative analysis was also performed between the GHP system and a conventional heating system that used diesel for fuel. In total, 34,000 one-day-old straight run broiler chicks were assigned to 2 broiler houses with 5 replicates in each (3,400 birds/replicate pen) for 35 d. Oxygen(,) CO(2), and NH(3) concentrations in the broiler house, energy consumption and cost of heating, and production performance of broilers were evaluated. Results showed that the final BW gain significantly (P < 0.05) increased when chicks were reared in the GHP broiler house compared with that of chicks reared in the conventional broiler house (1.73 vs. 1.62 kg/bird). The heating system did not affect the mortality of chicks during the first 4 wk of the experimental period, but the mortality markedly increased in the conventional broiler house during the last wk of the experiment. Oxygen content in the broiler house during the experimental period was not affected by the heating system, but the CO(2) and NH(3) contents significantly increased (P < 0.05) in the conventional broiler house compared with those in the GHP house. Fuel consumption was significantly reduced (P < 0.05) and electricity consumption significantly increased (P < 0.05) in the GHP house compared with the consumption in the conventional house during the experiment. The total energy cost of heating the GHP house was significantly lower (P < 0.05) compared with that of the conventional house. It is concluded that a GHP system could increase the production performance of broiler chicks due to increased inside air quality of the broiler house. The GHP system had lower CO(2) and NH(3) emissions with lower energy cost than the conventional heating system for broiler chickens.

Effects of washing methods on gel properties of chicken surimi prepared from spent hen breast muscle.

In this study, 2 myofibrillar protein extraction methods were compared for the preparation of chicken surimi using spent hen breast muscle. One method involved 1 washing with 0.1, 0.5, or 1% sodium chloride solution followed by 2 washings with distilled water, with homogenization and centrifugation of the breast muscle after each washing (new method; NM). The other method used only distilled water for the extraction, and washing was repeated 3 times followed by homogenization and centrifugation of the breast muscle after each washing (conventional method; CM). The redness values of the batter as well as the cooked gel were significantly lower (P < or = 0.05) by NM as compared with CM. In addition, the SDS-PAGE of NM sarcoplasmic protein fractions showed phosphorylase bands with increased staining intensity as compared with CM, indicating that brightness was related to the sarcoplasmic protein fractions. Overall, the data implied that sodium chloride solution was more appropriate for the myofibrillar protein extraction of spent hen breast muscle than the commonly used distilled water method.