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Researchers pinpoint the risk of ESRD for kidney donors
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A study by Wainright and colleagues in the American Journal of Transplantation looked for characteristics of kidney donors having end-stage renal disease later in life.
In a review of medical records from CMS data and on the Organ Procurement and Transplantation Network (OPTN) database of living kidney donors between 1994 and 2016 (n = 123,526), researchers found young black men and older white men with a greater BMI appeared to be at a greater risk than others to develop end-stage renal disease (ESRD) after donating a kidney.
“We hypothesize there is a 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.
In total, 218 of the 123,526 donors developed ESRD, with a median of 11.1 years between donation and ESRD. Although 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.
Nephrology News & Issues asked Jennifer L. Wainright, MD, PhD, lead author of the paper, for more details on the findings and whether the risk of ESRD should make people be more cautious about donating.
NN&I: Can you explain the “scatter” of these different confounders and the relation to the greater risk of ESRD? For example, young black donors and obese white donors are at higher risk for ESRD. Why not obese black donors and young white donors?
Jennifer L. Wainright, MD, PhD: We would expect a higher risk for obese black donors because being black and having a higher BMI were both significant risk factors in our model. You can interpret any of the other results in the same way, so a male identical twin donor would have a higher risk than a female unrelated donor because of his sex and because of his relationship to the recipient. The effect we found for higher risk for younger black donors is likely due to selection effects. African Americans who develop kidney disease tend to develop it earlier in life than white patients, so they would be screened out during the donor evaluation process.
NN&I: Could you gather any information in the data review about the level of care these individuals received after donation? Hypertension was a high-risk factor for donors to eventually develop ESRD, yet this is controllable with medications.
Wainright: Unfortunately, we do not have information about the level of care donors received after donating. These results suggest that all living kidney donors should receive regular medical care to monitor their kidney function and intervene early if they have problems.
NN&I: What would you tell individuals who want to donate who fall into these high-risk categories?
Wainright: Potential living kidney donors must understand that certain factors increase their risk of renal disease if they donate. They need to understand their own personal risk to make a decision that is right for them and to be able to give truly informed consent.