Risk of End-Stage Renal Disease Following Live Kidney Donation

Abstract

Risk of end-stage renal disease (ESRD) in kidney donors has been compared with risk faced by the general population, but the general population represents an unscreened, high-risk comparator. A comparison to similarly screened healthy nondonors would more properly estimate the sequelae of kidney donation.OBJECTIVES To compare the risk of ESRD in kidney donors with that of a healthy cohort of nondonors who are at equally low risk of renal disease and free of contraindications to live donation and to stratify these comparisons by patient demographics. DESIGN, SETTINGS, AND PARTICIPANTSA cohort of 96 217 kidney donors in the United States between April 1994 and November 2011 and a cohort of 20 024 participants of the Third National Health and Nutrition Examination Survey (NHANES III) were linked to Centers for Medicare & Medicaid Services data to ascertain development of ESRD, which was defined as the initiation of maintenance dialysis, placement on the waiting list, or receipt of a living or deceased donor kidney transplant, whichever was identified first. Maximum follow-up was 15.0 years; median follow-up was 7.6 years (interquartile range [IQR], 3.9-11.5 years) for kidney donors and 15.0 years (IQR, 13.7-15.0 years) for matched healthy nondonors. MAIN OUTCOMES AND MEASURES Cumulative incidence and lifetime risk of ESRD.RESULTS Among live donors, with median follow-up of 7.6 years (maximum, 15.0), ESRD developed in 99 individuals in a mean (SD) of 8.6 (3.6) years after donation. Among matched healthy nondonors, with median follow-up of 15.0 years (maximum, 15.0), ESRD developed in 36 nondonors in 10.7 (3.2) years, drawn from 17 ESRD events in the unmatched healthy nondonor pool of 9364. Estimated risk of ESRD at 15 years after donation was 30.8 per 10 000 (95% CI, 24.3-38.5) in kidney donors and 3.9 per 10 000 (95% CI, 0.8-8.9) in their matched healthy nondonor counterparts (P < .001). This difference was observed in both black and white individuals, with an estimated risk of 74.7 per 10 000 black donors (95% CI, 47.8-105.8) vs 23.9 per 10 000 black nondonors (95% CI, 1.6-62.4; P < .001) and an estimated risk of 22.7 per 10 000 white donors (95% CI, 15.6-30.1) vs 0.0 white nondonors (P < .001). Estimated lifetime risk of ESRD was 90 per 10 000 donors, 326 per 10 000 unscreened nondonors (general population), and 14 per 10 000 healthy nondonors. CONCLUSIONS AND RELEVANCECompared with matched healthy nondonors, kidney donors had an increased risk of ESRD over a median of 7.6 years; however, the magnitude of the absolute risk increase was small. These findings may help inform discussions with persons considering live kidney donation.

Understanding Antihypertensive Medication Use after Living Kidney Donation through Linked National Registry and Pharmacy Claims Data

“…A recent report of 103 African-American donors at two centers suggested that the frequency of post-donation hypertension may exceed that of matched controls, noting a high proportion of previously undiagnosed hypertension identified through study encounters [12]. Further, a new study of data for 96,217 US living donors identified a small but significant increase in ESRD risk attributable to donation that was highest in African-Americans [13], illustrating the need to understand mediators of disparities in post-donation ESRD. Management of hypertension may include lifestyle modification and close observation, followed by pharmacologic therapy with antihypertensive medications (AHM) in patients who do not achieve treatment goals [14,15].…”

End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline

“…ESRD is a life-threatening condition [4]. In young and healthy persons, the estimated risk of ESRD at 15 yr is 0.04% (95% CI, 0.008-0.09), reaching a peak of 0.3% (95% CI, 0.2-0.4) in healthy kidney donors [5]. Due to older age, high prevalence of associated comorbidities, and reduced number of nephrons, ESRD risk after surgery for renal cancer is significantly more common.…”

Does size really matter? A retrospective analysis of donor renal volume and its effects on renal function in donors after donation

“…Muzzale et al wrote that although there is an increased risk of ESRD in renal donors, the magnitude of absolute risk increase was very small, thus supporting our conclusion as well. [15] Future directions for this clinically and ethically important question would be with three dimensional radiological measurement of pre and post-operative renal volume and the usage of GFR with age, ethnicity and BMI factored in to investigate the relationship between residual renal volume and renal function in the renal donor. We eagerly await future research on this topic for validation of our findings.…”