Previous studies reported the risk of ESRD after kidney donation, but not the renal outcomes that precede ESRD. Here, we estimated the risk of proteinuria, reduced GFR, and ESRD in 3956 white kidney donors, assessed the contribution of postdonation hypertension and diabetes to these outcomes, and developed a risk calculator. After amean6SD follow-up of 16.6611.9 years, 215 (6.1%) donors developed proteinuria.Men had a higher risk of proteinuria (hazard ratio [HR], 1.56; 95%confidence interval [95%CI], 1.18 to 2.05; P,0.001) as did those with higher bodymass index (HR, 1.10; 95%CI, 1.06 to 1.13; P,0.001). In all, 1410 (36%) donors reached an EGFR,60 ml/min per 1.73 m2, and 112 (2.8%) donors had either an EGFR,30 ml/min per 1.73 m2 or ESRD (28 donors developed ESRD). An EGFR,30 ml/min per 1.73 m2 or ESRD associated with older age (HR, 1.07; 95% CI, 1.05 to 1.09; P,0.001), higher body mass index (HR, 1.08; 95% CI, 1.04 to 1.13; P,0.001), and higher systolic BP (HR, 1.02; 95% CI, 1.00 to 1.04; P=0.01) at donation. Postdonation diabetes and hypertension associated with a fourfold higher risk of proteinuria and a .2-fold higher risk of ESRD. Models predicting proteinuria and reduced EGFR performed well (C-index 0.77-1.00). In conclusion, severe reduction in GFR and ESRD after kidney donation were uncommon and were highly associated with postdonation diabetes and hypertension. Furthermore, information available before donation may predict long-term renal outcomes in white living kidney donors.
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