Hypertension, albuminuria risks may not differ between living kidney donors, nondonors
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Key takeaways:
- Overall, 161 donors and 158 nondonors had hypertension during follow-up.
- Longitudinal change in mean BP was similar between groups.
Hypertension and albuminuria risks may not significantly differ between living kidney donors and nondonors with the same follow-up schedule, according to published data.
“Hypertension and albuminuria may be more prevalent among donors in the decade after nephrectomy. However, the quality of this evidence has been assessed as poor, and it remains unclear whether observed risks are attributable to nephrectomy, hereditary factors ... or more follow-up assessments with a greater opportunity for outcome ascertainment in donors than nondonors,” Amit X. Garg, MD, PhD, of Lawson Health Research Institute and London Health Sciences, wrote with colleagues.
In a prospective cohort study, researchers examined 924 standard-criteria living kidney donors, enrolled before surgery, and a concurrent sample of 396 nondonors. The goal was to determine the risk of hypertension in adults who are normotensive and donated a kidney vs. similar nondonors, as well as evaluate eGFR decline and albuminuria risk.
Patients were recruited from 2004 to 2014 from 17 transplant centers in Canada and Australia and followed until 2021. Donors and nondonors had the same annual follow-up schedule. Researchers defined hypertension as systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg or antihypertensive medication; measured annualized eGFR change starting 12 months after donation or simulated donation; and underlined albumin to creatinine ratios of at least 3 mg/mmoL.
Mean age of the donors was 47 years and 66% were women. Mean eGFR was 100 mL/min/1.73 m2. Donors were more likely to have a family history of kidney failure.
The nondonor sample increased to 928 after statistical weighting, and baseline characteristics were similar between the groups. Overall, 161 donors and 158 nondonors had hypertension during a median 7.3-year follow-up, according to the results.
Longitudinal change in mean BP was similar. Following the initial decrease in eGFR after nephrectomy, donors had a 1.4 mL/min/1.73 m2 per year lesser decline of eGFR decline than nondonors. More donors than nondonors had an eGFR between 30 mL/min/1.73 m2 and 60 mL/min/1.73 m2 at least once in follow-up, according to Garg and colleagues.
Albuminuria occurred in 132 donors and 95 nondonors.
“The current findings of comparable outcomes between living kidney donors and nondonors support the safety of kidney donation and can be used to more confidently counsel donors on donation-attributable risks in the first 7 years after donation,” the researchers wrote. “Guideline-recommended follow-up testing and care to maintain good long-term donor health remain essential.”
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