TY - JOUR
T1 - Renal function profile in white kidney donors
T2 - The first 4 decades
AU - Ibrahim, Hassan N.
AU - Foley, Robert N.
AU - Reule, Scott A.
AU - Spong, Richard
AU - Kukla, Aleksandra
AU - Issa, Naim
AU - Berglund, Danielle M.
AU - Sieger, Gretchen K.
AU - Matas, Arthur J.
N1 - Funding Information:
Funding for this research was provided by the National Institutes of Health (NIH) as part of the Program Project Grant Studies of Organ Transplantation in Animals and Men (5P01 DK013083). The NIH had no role in study design, analysis, or preparation/review of the manuscript.
Publisher Copyright:
Copyright © 2016 by the American Society of Nephrology.
PY - 2016
Y1 - 2016
N2 - 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.
AB - 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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U2 - 10.1681/ASN.2015091018
DO - 10.1681/ASN.2015091018
M3 - Article
C2 - 26888476
AN - SCOPUS:85015847453
VL - 27
SP - 2885
EP - 2893
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
SN - 1046-6673
IS - 9
ER -