Long-term risks for kidney donors

Abstract

Previous studies have suggested that living kidney donors maintain long-term renal function and experience no increase in cardiovascular or all-cause mortality. However, most analyses have included control groups less healthy than the living donor population and have had relatively short follow-up periods. Here we compared long-term renal function and cardiovascular and all-cause mortality in living kidney donors compared with a control group of individuals who would have been eligible for donation. All-cause mortality, cardiovascular mortality, and end-stage renal disease (ESRD) was identified in 1901 individuals who donated a kidney during 1963 through 2007 with a median follow-up of 15.1 years. A control group of 32,621 potentially eligible kidney donors was selected, with a median follow-up of 24.9 years. Hazard ratio for all-cause death was significantly increased to 1.30 (95% confidence interval 1.11-1.52) for donors compared with controls. There was a significant corresponding increase in cardiovascular death to 1.40 (1.03-1.91), while the risk of ESRD was greatly and significantly increased to 11.38 (4.37-29.6). The overall incidence of ESRD among donors was 302 cases per million and might have been influenced by hereditary factors. Immunological renal disease was the cause of ESRD in the donors. Thus, kidney donors are at increased long-term risk for ESRD, cardiovascular, and all-cause mortality compared with a control group of non-donors who would have been eligible for donation.

Lifetime risk of renal replacement therapy in Europe: a population-based study using data from the ERA-EDTA Registry

“…The relative risk of RRT for ESRD is between 6 and 12 times higher in people who donated a kidney compared to equally healthy controls. [1,22] whether this elevated risk is acceptable depends on the absolute risk of RRT for the potential donor after donation. Together with information on a potential donor's risk factors and the relative risk induced by nephrectomy, country specific reference values for lifetime risk of RRT are needed to obtain this absolute risk of RRT after kidney donation.…”

Renal Function Profile in White Kidney Donors: The First 4 Decades

“…Previous studies, comparing donors to the general population or to healthy matched controls, have reported on the relatively rare event of ESRD. [1][2][3] Little attention, if any, has been paid to more common intermediate outcomes that are often harbingers of ESRD, such as the development of proteinuria or substantial decline in the GFR. In the United States, more common intermediate outcomes are not captured in the national donor registry.…”

What’s Hot, What’s New at WTC—Clinical Science

“…Long-term safety of living kidney donation Two recent publications have raised questions about an increased (though small) risk of renal failure after kidney donation, and have generated much discussion (10,11). A number of abstracts presented at this meeting reported long-term follow up in living donors.…”