April 24, 2018
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Study identifies donor types at greater risk for ESRD

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Young black men and older white men with a higher BMI who have donated a kidney are at greater risk than others to develop end-stage kidney disease later in life, according to a recently published study.

Jennifer L. Wainright, MD, PhD, and colleagues from the United Network for Organ Sharing looked at medical records from CMS data and the Organ Procurement and Transplantation Network (OPTN) database of living kidney donors between 1994 and 2016 (n = 123,526) to determine the risk for end-stage renal disease (ESRD).

“We hypothesize there is greater 20-year risk associated with donation for some donors, and this age effect varies by race,” the authors wrote. They also hypothesized that data would show the donor relationship to the recipient — a parent, child, sibling or identical twin — would influence ESRD risk.

The authors concluded the risk of developing kidney disease 20 years after donating a kidney is low. In total, 218 of the 123,526 donors developed ESRD, with a median of 11.1 years between donation and ESRD. While the risk was low, it was not similar and uniform in race, age and sex categories.

“[Living kidney donors] LKDs had increased risk of ESRD if they were male, had higher BMI or lower estimated [glomerular filtration rate] GFR (aHR: 0.89 per 10 mL/min, 95% CI: 0.80-0.99) ... ,” the authors wrote.

Parents had the greatest risk of developing ESRD, followed by a sibling who donated. A child had the lowest ESRD risk. Those who developed ESRD were less likely to live in wealthy neighborhoods among white and black donors, but not Hispanic donors, the authors found.

Of the group of donors who developed ESRD, 131 were added to the OPTN waiting list for a kidney. Of that group, 97 received a deceased donor kidney. Eleven received living donor kidney transplants, and 26 of the patients with ESRD were still on the waiting list by the end of the study. The chief diagnoses among the patients who developed ESRD were hypertension, glomerulonephritis and diabetes, the authors wrote.

Disclosures: The authors report no relevant financial disclosures.