Long-Term Renal Function and Cardiovascular Disease Risk in Obese Kidney Donors

Abstract

Background and objectives: Increasing demand for live-donor kidneys has encouraged the use of obese donors despite the absence of long-term outcome data and evidence that obesity can adversely affect renal function. We wished to determine whether obesity increased the risk for renal dysfunction and other medical comorbidities in donors several years after donation.Design, setting, participants, & measurements: Ninety-eight patients who donated a kidney 5 to 40 years previously were stratified according to body mass index (BMI) at donation and evaluated for renal dysfunction and risk factors for cardiovascular disease. Patients who were from the 2005 through 2006 National Health and Nutrition Examination Survey database; did not have renal disease; and were matched for age, gender, race, and BMI served as two-kidney control subjects.Results: Renal function in obese (BMI >30) and nonobese (BMI <30) donors was similar, and both donor groups had reduced renal function compared with BMI-matched two-kidney control subjects. Obesity was associated with more hypertension and dyslipidemias in both donors and two-kidney control subjects; however, there were no significant differences between the two groups within each BMI category.Conclusions: These results indicate that obese donors are not at higher risk for long-term reduced renal function compared with nonobese donors and that the increased incidence of hypertension and other cardiovascular disease risk factors in obese donors is due to their obesity and is not further exacerbated by nephrectomy. These findings support the current practice of using otherwise healthy overweight and obese donors but emphasize the need for more intensive preoperative education and postoperative health care maintenance in this donor group.

Barriers to Living Donor Kidney Transplantation among Black or Older Transplant Candidates

“…Unfortunately, decreasing ney donation are appropriately stringent given that donation has short-term (23,24) and possibly long-term (25,26) risks. Obesity, which occurs more commonly among black potential donors (11)(12)(13), has uncertain long-term risks for living donors (27,28). The medical criteria for accepting living donors should not be relaxed given the ethical imperative to protect the welfare of potential and actual donors (29).…”

Characteristics and clinical outcomes of living renal donors in Hong Kong

“…Although reports suggest that the incidence of hypertension among kidney donors increases, [16][17][18][19] others have not confirmed this observation. [20][21][22][23][24] In Hong Kong, the prevalence of hypertension in the general population was 12.6% in 2014, 25 which is lower than our reported figure of 18.2%. With the progression of time after surgery, however, the prevalence of hypertension among living donors is expected to increase as age is a known influence in hypertension.…”

Untitled

“…Several small retrospective studies have shown that there is no increased risk of deterioration in renal function in obese patients who donate a kidney during the first 5 years after surgery. [27][28][29] However, the follow-up duration was short, and these studies all concluded that overweight and obese kidney donors need intensive preoperative education and postoperative health maintenance. On the other hand, a recent cohort study of over 95 000 patients who underwent living-donor nephrectomy for kidney transplant demon strated an increased risk of end-stage renal disease over a median 7.6 years versus that shown in matched healthy nondonors.…”