Hypertension after kidney donation: Incidence, predictors, and correlates

Abstract

Incidence of postdonation hypertension, risk factors associated with its development, and impact of type of treatment received on renal outcomes were determined in 3700 kidney donors. Using Cox proportional hazard model, adjusted hazard ratios (HRs) for cardiovascular disease (CVD); estimated glomerular filtration rate (eGFR) <60, <45, <30 mL/min/1.73m ; end stage renal disease (ESRD); and death in hypertensive donors were determined. After a mean (standard deviation [SD]) of 16.6 (11.9) years of follow-up, 1126 (26.8%) donors developed hypertension and 894 with known antihypertensive medications. Hypertension developed in 4%, 10%, and 51% at 5, 10, and 40 years, respectively, and was associated with proteinuria, eGFR < 30, 45, and 60 mL/min/1.73m , CVD, and death. Blood pressure was <140/90 mm Hg at last follow-up in 75% of hypertensive donors. Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (compared to other antihypertensive agents) was associated with a lower risk for eGFR <45 mL/min/1.73m², HR 0.64 (95% confidence interval [CI] 0.45-0.9), P = .01, and also less ESRD; HR 0.03 (95% CI 0.001-0.20), P = .004. In this predominantly Caucasian cohort, hypertension is common after donation, well controlled in most donors, and factors associated with its development are similar to those in the general population.

Is Hypertension Following Donor Nephrectomy Cause For Elevated Living Donor Kidney Function Concern?

“…In this issue of CJASN, Holscher et al (4) provide worrisome data that self-reported hypertension is nearly 20% higher in live kidney donors who were followed longitudinally for up to 27 years postdonation compared with relatively healthy, matched nondonors. This study confirms prior reports (5,6). Furthermore, their work goes on to show that the development of hypertension in former kidney donors is associated with an interruption in the slow rise in eGFR that typically occurs over many years after kidney donation.…”

In sickness and in health: Living HIV positive kidney donation from a wife to her husband, with 7 years' post‐transplant follow‐up

“…The only complication was progression of hypertension. There is an increased risk of hypertension as well as worsening of the control of pre‐existing hypertension among kidney donors and factors associated with that are similar to those in the general population . The donor in our case was well‐controlled post‐donation with 2 antihypertensive medication and had no effect of hypertension on her kidney function or albumin excretion,…”

Increased long‐term risk for hypertension in kidney donors – a retrospective cohort study

“…This aspect has been addressed by Sanchez et al . . They evaluated occurrence of hypertension and time after donation.…”