Background: Living kidney donors have an increased risk of end-stage renal disease, with hypertension and diabetes as the predominant causes. In this study, we sought to better understand the timeline when these diseases occur, focusing on the early postdonation period.
Methods: We studied 41 260 living kidney donors in the United States between 2008 and 2014 from the Scientific Registry of Transplant Recipients and modeled incidence rates and risk factors for hypertension and diabetes.
Results: At 6 months, 1 year, and 2 years postdonation, there were 74, 162, and 310 cases, respectively, of hypertension per 10 000 donors. Donors who were older (per 10 y, adjusted incidence rate ratio [aIRR], 1.40; 95% confidence interval [CI], 1.29-1.51), male (aIRR, 1.31; 95% CI, 1.14-1.50), had higher body mass index (per 5 units, aIRR, 1.29; 95% CI, 1.17-1.43), and were related to their recipient (first-degree relative: aIRR, 1.28; 95% CI, 1.08-1.52; spouse: aIRR, 1.34; 95% CI, 1.08-1.66) were more likely to develop hypertension, whereas donors who were Hispanic/Latino were less likely (aIRR, 0.71; 95% CI, 0.55-0.93). At 6 months, 1 year, and 2 years, there were 2, 6, and 15 cases of diabetes per 10 000 donors. Donors who were older (per 10 y: aIRR, 1.42; 95% CI, 1.11-1.82), had higher body mass index (per 5 units: aIRR, 1.52; 95% CI, 1.04-2.21), and were Hispanic/Latino (aIRR, 2.45; 95% CI, 1.14-5.26) were more likely to develop diabetes.
Conclusions: In this national study, new-onset diabetes was rare, but 3% of donors developed hypertension within 2 years of nephrectomy. These findings reaffirm that disease pathways for kidney failure differ by donor phenotype and estimate the population most at-risk for later kidney failure.
Conflict of interest statement
The authors declare no conflicts of interest. The results presented in this paper have not been published previously in whole or part, except in abstract format.
Association Between Living Kidney Donor Postdonation Hypertension and Recipient Graft Failure.Transplantation. 2020 Mar;104(3):583-590. doi: 10.1097/TP.0000000000002832. Transplantation. 2020. PMID: 32106202
Association of Early Postdonation Renal Function With Subsequent Risk of End-Stage Renal Disease in Living Kidney Donors.JAMA Surg. 2020 Jan 22;155(3):e195472. doi: 10.1001/jamasurg.2019.5472. Online ahead of print. JAMA Surg. 2020. PMID: 31968070
Patterns of End-Stage Renal Disease Caused by Diabetes, Hypertension, and Glomerulonephritis in Live Kidney Donors.Am J Transplant. 2016 Dec;16(12):3540-3547. doi: 10.1111/ajt.13917. Epub 2016 Jul 12. Am J Transplant. 2016. PMID: 27287605 Free PMC article.
Risks and outcomes of living donation.Adv Chronic Kidney Dis. 2012 Jul;19(4):220-8. doi: 10.1053/j.ackd.2011.09.005. Adv Chronic Kidney Dis. 2012. PMID: 22732041 Free PMC article. Review.
Why should we implement living donation in renal transplantation?Clin Nephrol. 2000 Apr;53(4):suppl 55-63. Clin Nephrol. 2000. PMID: 10809438 Review.
Cited by 1 article
Postdonation eGFR and New-Onset Antihypertensive Medication Use After Living Kidney Donation.Transplant Direct. 2019 Jul 25;5(8):e474. doi: 10.1097/TXD.0000000000000913. eCollection 2019 Aug. Transplant Direct. 2019. PMID: 31576370 Free PMC article.
- K01 DK101677/DK/NIDDK NIH HHS/United States
- K01 DK114388/DK/NIDDK NIH HHS/United States
- R01 DK096008/DK/NIDDK NIH HHS/United States
- F32 AG053025/AG/NIA NIH HHS/United States
- F32 DK105600/DK/NIDDK NIH HHS/United States