Kidney donation may increase hypertension risk but shows no link to cardiovascular disease
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A study of living kidney donors in Denmark found that while donation was associated with a greater risk for hypertension, it did not appear to increase the likelihood of donors developing cardiovascular disease.
“Kidney donors are carefully selected, inherently healthy and often also biological and/or socially related to patients with kidney disease and thus, identifying a relevant comparison group remains a major challenge in observational studies,” Philip Munch, MD, of Aarhus University Hospital, and colleagues wrote. “Consequently, the results of such studies might be confounded by a greater baseline risk of CVD in the comparison cohort leading to an underestimation of the relative risk in kidney donors.”
To gain a better understanding of CVD risk 10 years after donation, Munch and colleagues compared outcomes between living kidney donors and cohorts of external blood donors and “healthy individuals” from the general population. No participants had had diagnoses of chronic liver disease, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, cancer or autoimmune disease.
Considered outcomes included risk for hypertension, atrial fibrillation/flutter, major adverse cardiovascular events ([MACE], defined as a composite of myocardial infarction, ischemic stroke and mortality) or mortality.
After 10 years, researchers found the risk for hypertension between kidney donors and the general population cohort was “virtually similar,” with kidney donors having a decreased risk for AF, MACE and all-cause mortality (hazard ratios [HRs] of 1.11, 0.59, 0.68 and 0.57, respectively).
Comparisons between kidney donors and blood donors showed that while kidney donors had an increased risk of initiating treatment for hypertension (standardized incidence ratio [SIR] = 1.40), they did not have an increased risk for MACE, AF or morality (SIRs of 1.17, 0.88 and 1.10, respectively).
Munch and colleagues wrote that it is unclear whether the “slightly increased” risk for initiating treatment for hypertension “reflects a greater risk of hypertension or represents surveillance bias, confounding and/or differences in the threshold for treatment.”
Thus, they argued that while regular follow-up care for kidney donors remains important, “the lack of associations between living kidney donation and CVD as well as death ... supports the safety of living kidney donation based on current principles involving rigorous medical examination and strict requirements for living kidney donation.”
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