Cardiovascular Disease and Hypertension Risk in Living Kidney Donors: An Analysis of Health Administrative Data in Ontario, Canada

Garg, Amit X.; Prasad, G. V. Ramesh; Thiessen-Philbrook, Heather; Li, Ping; Melo, Magda; Gibney, Eric M.; Knoll, Greg; Karpinski, Martin; Parikh, Chirag R.; Gill, John S.; Storsley, Leroy; Vlasschaert, Meghan; Mamdani, Muhammad

doi:10.1097/tp.0b013e31817ba9e3

Cited by 133 publications

(117 citation statements)

References 34 publications

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“…Among living donors with private health insurance, African Americans and Hispanics have an increased risk of hypertension and diabetes and an incidence of ESRD of 0.13% at a median 7.7 years of follow-up after donation (6). The rate of selected comorbid conditions, including cancers, cardiovascular disease, depression, and fractures, following living donation is also generally similar to that among individuals characterized as the "healthiest" portion of the general population and among age-and sex-matched controls with commercial insurance (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 62%

Hospitalizations Following Living Donor Nephrectomy in the United States

Schold

Goldfarb

Buccini

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Living donors represented 43% of United States kidney donors in 2012. Although research suggests minimal long-term consequences of donation, few comprehensive longitudinal studies for this population have been performed. The primary aims of this study were to examine the incidence, risk factors, and causes of rehospitalization following donation.Design, setting, participants, & measurements State Inpatient Databases (SID) compiled by the Agency for Healthcare Research and Quality were used to identify living donors in four different states between 2005 and 2010 (n=4524). Multivariable survival models were used to examine risks for rehospitalization, and patient characteristics were compared with data from the Scientific Registry of Transplant Recipients (SRTR). Outcomes among patients undergoing appendectomy (n=200,274), cholecystectomy (n=255,231), and nephrectomy for nonmetastatic carcinoma (n=1314) were contrasted.Results The study population was similar to United States donors (for SRTR and SID, respectively: mean age, 41 and 41 years; African Americans, 12% and 10%; women, 60% and 61%). The 3-year incidence of rehospitalization following donation was 11% for all causes and 9% excluding pregnancy-related hospitalizations. After censoring of models for pregnancy-related rehospitalizations, older age (adjusted hazard ratio [AHR], 1.02 per year; 95% confidence interval [95% CI], 1.01 to 1.03), African American race (AHR, 2.16; 95% CI, 1.54 to 3.03), depression (AHR, 1.88; 95% CI, 1.12 to 3.14), hypothyroidism (AHR, 1.63; 95% CI, 1.06 to 2.49), and longer initial length of stay were related to higher rehospitalization rates among donors. Compared with living donors, adjusted risks for rehospitalizations were greater among patients undergoing appendectomy (AHR, 1.58; 95% CI, 1.42 to 1.75), cholecystectomy (AHR, 2.25; 95% CI, 2.03 to 2.50), and nephrectomy for nonmetastatic carcinoma (AHR, 2.95; 95% CI, 2.58 to 3.37). Risks for rehospitalizations were higher among African Americans than whites in each of the surgical groups.Conclusions The SID is a valuable source for evaluating characteristics and outcomes of living kidney donors that are not available in traditional transplant databases. Rehospitalizations following donor nephrectomy are less than seen with other comparable surgical procedures but are relatively higher among donors who are older, are African American, and have select comorbid conditions. The increased risks for rehospitalizations among African Americans are not unique to living donation.

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Section: Introductionmentioning

confidence: 62%

Hospitalizations Following Living Donor Nephrectomy in the United States

Schold

Goldfarb

Buccini

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…In the absence of a non-donor control population, the extent to which incident hypertension is attributable to kidney donation is difficult to judge. A retrospective study of over 1,200 living kidney donors, with a mean follow-up of 6.4 years, found that donors had a 40% increased risk (hazard ratio, 1.4; CI, 1.2-1.7) of being diagnosed with hypertension compared with that of non-donor controls (24). A recent study from the UK pooled 8 Lisinopril 9 ---10 ---11 ---12 ---13 ---14 ---15 ---16 ---17 ---18 ---19 --Atenolol 20 --HCTZ 21 ---HCTZ, hydrochlorothiazide.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal study of living kidney donor glomerular dynamics after nephrectomy

Lenihan¹,

Busque²,

Derby³

et al. 2015

J. Clin. Invest.

153

100

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ResultsResponse to donor nephrectomy in healthy humans. Twenty-one subjects underwent clinical, physiological, and radiological assessments immediately before, early after (median, 0.8 years), and late after (median, 6.1 years) (hereafter, pre-donation, early post-donation, and late post-donation) living kidney donation. A morphometric evaluation of glomeruli was performed on renocortical tissue that was obtained by wedge biopsy at the time of donor nephrectomy in 19 subjects. Baseline demographic, physio-BACKGROUND. Over 5,000 living kidney donor nephrectomies are performed annually in the US. While the physiological changes that occur early after nephrectomy are well documented, less is known about the long-term glomerular dynamics in living donors. METHODS.We enrolled 21 adult living kidney donors to undergo detailed long-term clinical, physiological, and radiological evaluation pre-, early post-(median, 0.8 years), and late post-(median, 6.3 years) donation. A morphometric analysis of glomeruli obtained during nephrectomy was performed in 19 subjects.RESULTS. Donors showed parallel increases in single-kidney renal plasma flow (RPF), renocortical volume, and glomerular filtration rate (GFR) early after the procedure, and these changes were sustained through to the late post-donation period. We used mathematical modeling to estimate the glomerular ultrafiltration coefficient (K f ), which also increased early and then remained constant through the late post-donation study. Assuming that the filtration surface area (and hence, K f ) increased in proportion to renocortical volume after donation, we calculated that the 40% elevation in the single-kidney GFR observed after donation could be attributed exclusively to an increase in the K f . The prevalence of hypertension in donors increased from 14% in the early post-donation period to 57% in the late post-donation period. No subjects exhibited elevated levels of albuminuria. CONCLUSIONS.Adaptive hyperfiltration after donor nephrectomy is attributable to hyperperfusion and hypertrophy of the remaining glomeruli. Our findings point away from the development of glomerular hypertension following kidney donation.

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“…The same study also noted that donors were seen more often by their primary care physicians, raising the possibility that the increased prevalence might have been due to increased monitoring. 44 In the University of Minnesota Study, mean 'office' systolic BP in the 255 patients following nephrectomy was 122 mm Hg, significantly lower than an age-matched control population. 35 The prevalence of hypertension requiring drug therapy was 25%, not significantly different from the figure of 29% in the control population.…”

Section: Risk Of Hypertension After Kidney Donationmentioning

confidence: 99%

Understanding the effects of chronic kidney disease on cardiovascular risk: are there lessons to be learnt from healthy kidney donors?

et al. 2011

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Chronic kidney disease (CKD) is now a recognized global public health problem. It is highly prevalent and strongly associated with hypertension and cardiovascular disease (CVD); far more patients with a glomerular filtration rate below 60 ml min À1 per 1.73 m 2 will die from cardiovascular causes than progress to end-stage renal disease. A better understanding of the complex mechanisms underlying the development of CVD among CKD patients is required if we are to begin devising therapy to prevent or reverse this process. Observational studies of CVD in CKD are difficult to interpret because renal impairment is almost always accompanied by confounding factors. These include the underlying disease process itself (for example, diabetes mellitus and systemic vasculitis) and the complications of CKD, such as hypertension, anaemia and inflammation. Kidney donors provide an ideal opportunity to study healthy subjects without manifest vascular disease who experience an acute change from having normal to modestly impaired renal function at the time of uninephrectomy. Prospectively examining the cardiovascular consequences of uninephrectomy using donors as a model of CKD may provide useful insight into the pathophysiology of CVD in CKD and, therefore, into how the CVD risk associated with renal impairment might eventually be reduced.

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Cardiovascular Disease and Hypertension Risk in Living Kidney Donors: An Analysis of Health Administrative Data in Ontario, Canada

Cited by 133 publications

References 34 publications

Hospitalizations Following Living Donor Nephrectomy in the United States

Hospitalizations Following Living Donor Nephrectomy in the United States

Longitudinal study of living kidney donor glomerular dynamics after nephrectomy

Understanding the effects of chronic kidney disease on cardiovascular risk: are there lessons to be learnt from healthy kidney donors?

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