Ethnic and Gender Related Differences in the Risk of End-Stage Renal Disease After Living Kidney Donation

Cherikh, Wida S.; Young, Carlton J.; Kramer, Beverley; Taranto, S.; Randall, Henry B.; Fan, Pang Yen

doi:10.1111/j.1600-6143.2011.03609.x

Cited by 122 publications

(119 citation statements)

References 11 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…Reported postdonation ESRD rates are higher for blacks and Hispanics than for whites, male patients, and younger donors. However, the ethnicity-and sex-related differences are similar to those observed in the general population with two kidneys (48,49).…”

Section: Risk For Esrdmentioning

confidence: 48%

“…In the largest series to date, Cherikh et al reported that 126 former donors have been put on the waiting list for transplantation in the United States (48). This may underestimate the rate of ESRD in that some developing ESRD may no opt for transplantation or have received an LD transplant.…”

Section: Risk For Esrdmentioning

confidence: 99%

“…Some kidney donors have developed ESRD (10)(11)(12)14,48,49). In the largest series to date, Cherikh et al reported that 126 former donors have been put on the waiting list for transplantation in the United States (48).…”

Section: Risk For Esrdmentioning

confidence: 99%

See 2 more Smart Citations

The Unjustified Classification of Kidney Donors as Patients with CKD

Matas

Ibrahim

2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryUnilateral nephrectomy for kidney donation results in loss of about 30% of baseline GFR, leaving some donors with GFR <60 ml/min per 1.73 m 2 , 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 <10 years, have shown an association between GFR <60 ml/min per 1.73 m 2 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 (6-45 years) have not shown excess mortality or ESRD. The limitation of the collective evidence is that the increased risks associated with GFR <60 ml/min per 1.73 m 2 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. In addition, the increasing number of patients who are interested in and are eligible for a kidney transplant has not been associated with a commensurate increase in the number of DD organs. This has resulted in a markedly longer waiting time on the list. The increasing waiting time for a DD transplant and the poor shortand mid-term results with dialysis have put increased emphasis on living donation. The major disadvantage of an LD transplant is the risk to the donor. Studies over the last three decades have noted a perioperative donor mortality rate of 3 in 10,000 (0.03%) and a major complication rate of ,1% (3-5). Laparoscopic nephrectomy is associated with quicker recovery than open nephrectomy but carries similar risk. To date, long-term follow-up studies report that donors, compared with controls, have similar or better survival rates, and perhaps lower rates of development of . In addition, donor quality of life after donation is excellent (15). Of concern, however, is that recent studies in the nondonor general population have suggested that reduced renal function is associated with increased cardiovascular and all-cause mortality; consequently, some former donors have had problems obtaining life and health insurance or are being forced to pay higher premiums (16,17). At the same time, some former donors with stable renal function have been labeled as having CKD. Herein, we review level of renal function after donation and the data on long-term survival and risk of ESRD after kidney donation. Definition of CKDMany observation studies have shown the a...

show abstract

Section: Risk For Esrdmentioning

confidence: 48%

Section: Risk For Esrdmentioning

confidence: 99%

See 1 more Smart Citation

The Unjustified Classification of Kidney Donors as Patients with CKD

Matas

Ibrahim

2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…In the current study, male sex, baseline hypertension, and African American race were independently associated with perioperative complications in multivariable models. These same characteristics have also been associated with increased risk of later medical complications, ESRD, and death within other donor cohorts (10)(11)(12). Whether early complications play a mediating role in the long-term risks needs to be defined in data sources (or primary studies) capturing longitudinal outcomes.…”

mentioning

confidence: 99%

Better Understanding Live Donor Risk through Big Data

Lentine

Segev

2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

In the context of the organ shortage, kidney transplantation from living donors has increased markedly over the last several decades. This growth in living donation has been accompanied by changes in donor characteristics, including greater racial and ethnic diversity and more unrelated donors (1). Recent studies also suggest an increase in donation from persons with baseline medical complexity, including obesity, hypertension, glucose intolerance, and even reduced renal function (2,3). However, capture of early complications by the national transplant registry has suffered from frequent missing data and under-reporting. Early postoperative complications reported by transplant centers to the Organ Procurement and Transplantation Network (OPTN) on the living donor registration form (submitted at discharge or within 6 weeks of the donation hospitalization) in 2000-2012 indicated the need for blood transfusion in 0.4%, vascular complications in 0.3%, readmission in 2.1%, reoperation in 0.5%, and other interventions in 0.8% (4). These center-reported frequencies are markedly lower than estimates of 3%-6% for major complications and 18%-22% for minor complications based on application of the Clavien classification system to sources such as a prospective Norwegian donor registry and United States hospital coding data (5).On the background of uncertainty regarding the true distribution of perioperative complications after donor nephrectomy, a new article by Schold et al. illustrates an innovative approach (6). Using data from the Nationwide Inpatient Sample (NIS), an all-payer inpatient care database comprising a stratified sample of 20% of nonfederal United States hospitals from participating states, the investigators identified living kidney donors in 1998-2010 on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes. Baseline comorbidity and complications during the hospitalization of the nephrectomy procedure (and thus presumably related to it, although timing of the various codes is not specified in NIS) were ascertained by diagnosis codes, and the frequency of complications was compared with that among patients who underwent appendectomy, cholecystectomy, and nephrectomy for nonmetastatic cancer. The authors reported a sample equivalent of 69,117 donors. Of note, in studies of NIS the actual number of patients from whom inferences are drawn is usually about one tenth the size of the sample equivalent size. In other words, one would estimate that approximately 7000 actual donors were identified and studied (similar to subject counts of 6300-9400 in recent studies identifying donor nephrectomies from the NIS directly in comparable time periods without the use of weighting [7,8]), but these represented about 70,000 donors nationally because of the sampling scheme used by NIS (and the weighted sample is more representative of the national population than an unweighted sample).Among donors identified in NIS, the proportion of documented baseline como...

show abstract

“…Recently, Muzaale and colleagues reported a higher risk of devel oping ESRD among kidney donors than among healthy non-donors [28]. Previous studies had shown no significant effect of kidney donation on the risk of developing ESRD [29,30]. The study by Muzaale et al [28] has received considerable criticism regards to the methodology used and limitations of the control groups, such as disparities between the decades in which the control and donor population data were extracted.…”

Section: Advantages Of Living Donor Transplantationmentioning

confidence: 80%

Live Donor Kidney Transplantation Pearls: A Practical Review

Matter¹,

Abbas²,

Nagib³

et al. 2017

UNOAJ

View full text Add to dashboard Cite

Living donation is "a gift of extraordinary value". The use of living donors for renal transplantation was critical for the early development of the field and preceded the use of cadaveric donors. Most donors are related genetically to the recipient, but there are an increasing percentage of cases, where donors are genetically unrelated like spouses, friends, or other emotionally related individuals. Ethical guidelines mandate that the living donors should not be coerced without any evidence of financial profit for the donor. Living donation has been associated with a higher success rate than that seen with cadaveric donation. Conclusion:In view of higher demand for transplantation and the lack of a parallel increase in the number of available cadaveric organs, living donation is important solution for patients to avoid long times on waiting list, and occasionally, even the need of dialysis so, much efforts are needed to encourage living donation rates.

show abstract

Ethnic and Gender Related Differences in the Risk of End-Stage Renal Disease After Living Kidney Donation

Cited by 122 publications

References 11 publications

The Unjustified Classification of Kidney Donors as Patients with CKD

The Unjustified Classification of Kidney Donors as Patients with CKD

Better Understanding Live Donor Risk through Big Data

Live Donor Kidney Transplantation Pearls: A Practical Review

Contact Info

Product

Resources

About