TY - JOUR
T1 - Postdonation eGFR and New-Onset Antihypertensive Medication Use after Living Kidney Donation
AU - Lentine, Krista L.
AU - Holscher, Courtenay M.
AU - Naik, Abhijit S.
AU - Lam, Ngan N.
AU - Segev, Dorry L.
AU - Garg, Amit X.
AU - Axelrod, David
AU - Xiao, Huiling
AU - Henderson, MacEy L.
AU - Massie, Allan B.
AU - Kasiske, Bertram L.
AU - Hess, Gregory P.
AU - Hsu, Chi Yuan
AU - Park, Meyeon
AU - Schnitzler, Mark A.
N1 - Funding Information:
U.S. Government. This work was supported in part by NIH grant F32DK109662 (C.M.H.) and R01 R01DK120551 (K.L.L., C.Y.H., M.P., and M.A.S.). The authors declare no conflicts of interest. K.L.L. and C.M.H. contributed equally to this work. K.L.L. and M.A.S. participated in study design, acquisition of data and regulatory approvals, data analysis, and writing of the article. C.M.H., A.S.N., N.N.L., D.L.S., A.X.G., D.A., M.L.H., A.M.B., B.L.K., G.P.H., C.H., and M.P. participated in study design, interpretation, and writing of the article. H.X. participated in data analysis and article preparation. Correspondence: Krista L. Lentine, MD, PhD, Saint Louis University Center for Abdominal Transplantation, 1402 S. Grand Blvd., St. Louis, MO 63104. (krista. [email protected]). Copyright © 2019 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Funding Information:
Received 10 April 2019. Revision received 13 May 2019. Accepted 21 May 2019. 1Saint Louis University, St. Louis, MO. 2Johns Hopkins University, Baltimore, MD. 3University of Michigan, Ann Arbor, MI. 4University of Alberta, Edmonton, AB, Canada. 5Western University, London, ON, Canada. 6University of Iowa, Iowa City, IA. 7Hennepin Healthcare, Minneapolis, MN. 8University of Pennsylvania, Philadelphia, PA. 9University of California, San Francisco, San Francisco, CA. This work was conducted under the auspices of the Minneapolis Medical Research Foundation (MMRF), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a U.S. Government-sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the
Funding Information:
The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for article editing. This work was supported in part by NIH grants F32DK109662 (C.M.H.) and R01 R01DK120551 (K.L.L., C.Y.H., M.P., and M.A.S.). An abstract describing portions of this work was presented at the American Transplant Congress 2018, Seattle, WA.
Publisher Copyright:
© 2019 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Background. Limited data are available regarding clinical implications of lower renal function after living kidney donation. We examined a novel integrated database to study associations between postdonation estimated glomerular filtration rate (eGFR) and use of antihypertensive medication (AHM) treatment after living kidney donation. Methods. Study data were assembled by linking national U.S. transplant registry identifiers, serum creatinine (SCr) values from electronic medical records, and pharmacy fill records for 3222 living donors (1989-2016) without predonation hypertension. Estimated GFR (mL/min per 1.73 m2) was computed from SCr values by the CKD-EPI equation. Repeated measures multivariable mixed effects modeling examined the associations (adjusted odds ratio, 95%LCLaOR95% UCL) between AHM use and postdonation eGFR levels (random effect) with fixed effects for baseline donor factors. Results. The linked database identified an average of 3 postdonation SCr values per donor (range: 1-38). Lower postdonation eGFR (vs ≥75) bore graded associations with higher odds of AHM use (eGFR 30-44: aOR 0.951.472.26; <30: aOR 1.082.525.90). Other independent correlates of postdonation AHM use included older age at donation (aOR per decade: 1.081.231.40), black race (aOR 1.031.512.21), body mass index > 30 kg/m2 (aOR 1.011.452.09), first-degree donor-recipient relationship (aOR 1.071.381.79), "prehypertension" at donation (systolic blood pressure 120-139: aOR 1.101.461.94; diastolic blood pressure 80-89: aOR 1.061.451.99). Conclusions. This novel linkage illustrates the ability to identify postdonation kidney function and associate it with clinically meaningful outcomes; lower eGFR after living kidney donation is a correlate of AHM treatment requirements. Further work should define relationships of postdonation renal function, hypertension, and other morbidity measures.
AB - Background. Limited data are available regarding clinical implications of lower renal function after living kidney donation. We examined a novel integrated database to study associations between postdonation estimated glomerular filtration rate (eGFR) and use of antihypertensive medication (AHM) treatment after living kidney donation. Methods. Study data were assembled by linking national U.S. transplant registry identifiers, serum creatinine (SCr) values from electronic medical records, and pharmacy fill records for 3222 living donors (1989-2016) without predonation hypertension. Estimated GFR (mL/min per 1.73 m2) was computed from SCr values by the CKD-EPI equation. Repeated measures multivariable mixed effects modeling examined the associations (adjusted odds ratio, 95%LCLaOR95% UCL) between AHM use and postdonation eGFR levels (random effect) with fixed effects for baseline donor factors. Results. The linked database identified an average of 3 postdonation SCr values per donor (range: 1-38). Lower postdonation eGFR (vs ≥75) bore graded associations with higher odds of AHM use (eGFR 30-44: aOR 0.951.472.26; <30: aOR 1.082.525.90). Other independent correlates of postdonation AHM use included older age at donation (aOR per decade: 1.081.231.40), black race (aOR 1.031.512.21), body mass index > 30 kg/m2 (aOR 1.011.452.09), first-degree donor-recipient relationship (aOR 1.071.381.79), "prehypertension" at donation (systolic blood pressure 120-139: aOR 1.101.461.94; diastolic blood pressure 80-89: aOR 1.061.451.99). Conclusions. This novel linkage illustrates the ability to identify postdonation kidney function and associate it with clinically meaningful outcomes; lower eGFR after living kidney donation is a correlate of AHM treatment requirements. Further work should define relationships of postdonation renal function, hypertension, and other morbidity measures.
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U2 - 10.1097/TXD.0000000000000913
DO - 10.1097/TXD.0000000000000913
M3 - Article
AN - SCOPUS:85079611113
SN - 2373-8731
VL - 5
JO - Transplantation Direct
JF - Transplantation Direct
IS - 8
M1 - e474
ER -