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Living kidney donation increases risk for higher BP, poor kidney function
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Although adult living kidney donors do not have a heightened risk for certain health outcomes of prior concern, such as CVD and type 2 diabetes, the procedure is linked to higher BP, end-stage renal disease and preeclampsia, according to findings published in Annals of Internal Medicine.
“Although living donation is highly beneficial to recipients, it remains a complex ethical, moral, and medical issue,” Emanuele Di Angelantonio, MD, senior author from the University of Cambridge, England, and colleagues wrote. “It is practiced with the expectation that risk for minimal short- and long-term harm to the donor is outweighed by the psychological benefits of altruism and improved recipient health... However, the mid- and long-term health risks remain uncertain.”
To address this gap in knowledge, Di Angelantonio and colleagues conducted a systematic review and meta-analysis of 52 studies that compared adult living kidney donors with nondonors for health outcomes and had at least 1 year of follow-up. The studies included 118,426 living kidney donors and 117,656 nondonors and had an average follow-up that ranged in duration from 1 to 24 years.
The researchers found the risk for all-cause mortality, CVD, hypertension, type 2 diabetes or adverse psychosocial health outcomes were not higher in living kidney donors compared with nondonors.
However, donors demonstrated higher diastolic BP and lower estimated glomerular filtration rates, as well as a greater risk for end-stage renal disease (RR = 8.83; 95% CI, 1.02-20.93]) and preeclampsia (RR = 2.12; 95% CI, 1.06-4.27) in women. The absolute risk for end-stage renal disease (incidence rate = 0.5 event per 1,000 person-years; 95% CI, 0.1-4.9 events) and preeclampsia (incidence rate = 5.9 events per 100 pregnancies; 95% CI, 2.9-8.9 events) was low among donors despite the elevated RR.
“This systematic review supports and expands previous research suggesting that living kidney donors have no increased risk for several major chronic diseases, with the exception of end-stage renal disease,” Di Angelantonio told Healio Internal Medicine.
“This study highlights the low but real risks of living kidney donation and emphasizes the importance of careful assessment and counseling for all living kidney donors,” he continued. “While this systematic review and meta-analysis provide some important answers, the field is still a long way from offering precise risk estimates to prospective donors.”
In an accompanying editorial, Emilio D. Poggio, MD, from Cleveland Clinic, and Peter P. Reese, MD, MSCE, from the University of Pennsylvania, wrote that the findings by Di Angelantonio and colleagues offer insight into the medical risk associated with kidney donation.
“However, a close look at the data reminds us that long-term outcomes are uncertain, and that precision medicine has not arrived for risk prediction in kidney donors,” they wrote. “In the meantime, we should do our best to protect potential donors with careful selection, candor about harms, open discussion about unknowns, and a commitment to their lifelong health after nephrectomy. Those goals give us plenty of work to do.” – by Alaina Tedesco
Disclosure: Di Angelantonio reports receiving grants from the National Institute for Health Research, National Health Service Blood and Transplant and the U.K. Medical Research Council and British Heart Foundation. Reese reports being an associate editor for the American Journal of Kidney Diseases and receiving support from Merck and CVS Caremark and consulting with COHRDATA. All other authors report no relevant financial disclosures.