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Lower mortality rate found among living kidney donors with ESRD than non-donors
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Living kidney donors with end-stage renal disease had a lower mortality rate compared to matched non-donors, according to a study that will appear in the Kidney International Reports.
"We found in a national, multiyear study of the U.S. incident hemodialysis population that patients who were prior kidney donors had a significantly lower risk of death compared to a propensity-matched cohort who did not have a history of kidney donation,” study co-author Rahul M. Jindal, MD, PhD, from the department of surgery and division of global health at the Uniformed Services University of the Health Sciences, told Healio Nephrology.
Mortality was 19% in donors compared to 49% in non-donors, and the lower mortality rate was consistent up to 10 years. Researchers were unable to estimate rates after 10 years due to the small sample size.
“Since prior organ donors who reach [end-stage renal disease] ESRD are given priority in the allocation of deceased donor kidneys, the higher transplant rates are likely one of the key drivers of their survival advantage compared to non-donors with ESRD,” Jindal said.
Researchers used the United States Renal Data System to look at 274 prior living kidney donors between 1995 and 2009. Using a time-dependent Cox proportional hazards model, they compared survival between 258 donors and 258 non-donors, all with Medicare as primary payer upon dialysis initiation.
Patients in the non-donor group were more likely to have diabetes and hypertension as the primary cause of ESRD, according to the researchers; however, ESRD was more likely to be caused by glomerulonephritis in donors.
Several potential explanations for the survival advantage among prior donors were noted. Donors may have greater motivation to maintain healthy habits and adhere to treatment regimens, and they may be in a better socioeconomic status thus having better access to health care. A greater percentage of donors had a college education and private insurance.
“We anticipate that our study findings would provide further guidance in obtaining informed consent and facilitate communication between clinicians and prospective donors during the donor evaluation process,” Jindal said. – by Jake Scott
Disclosures: The authors report no relevant financial disclosures.
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