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Long-term risk for kidney donors with hypertension at donation - a retrospective cohort study
Anders J Haugen1,2, Nina E Langberg1, Dag Olav Dahle1
1Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Insights
Hypertension in kidney donors does not appear to increase long-term mortality risk. This study suggests older kidney donors with high blood pressure may still be suitable candidates for donation.
Area of Science:
- Nephrology
- Cardiology
- Transplantation
Background:
- Elevated blood pressure (hypertension) is linked to increased mortality in the general population.
- The long-term impact of hypertension on kidney donor mortality is less understood.
- Kidney donation involves careful donor selection to ensure long-term health outcomes.
Purpose of the Study:
- To evaluate the association between hypertension at the time of kidney donation and long-term overall and cardiovascular mortality.
- To compare mortality rates in hypertensive kidney donors versus normotensive kidney donors.
- To inform donor selection criteria regarding pre-existing hypertension.
Main Methods:
- Retrospective analysis of 2131 kidney donors with available records.
- Hypertension defined as blood pressure >140/90 mmHg or antihypertensive medication use.
- Multivariable regression analyses to assess overall and cardiovascular mortality after a median follow-up of 20.8 years.
Main Results:
- Hypertensive donors were older, more likely male, had higher BMI, and lower estimated glomerular filtration rate (eGFR).
- Multivariable analysis showed no significant association between hypertension at donation and increased long-term overall mortality (HR 1.1, 95% CI 0.9-1.5).
- No significant association was found between hypertension at donation and increased long-term cardiovascular mortality (HR 1.1, 95% CI 0.7-1.8).
Conclusions:
- Hypertension at the time of kidney donation does not appear to be a contraindication for donation.
- These findings may support the inclusion of older, otherwise healthy kidney donors with hypertension.
- Further research could explore the impact of controlled hypertension on donor outcomes.
Abstract:
In the general population, small increases in blood pressure are associated with increased mortality. In kidney donors this association is less certain. We therefore assessed long-term overall and cardiovascular mortality in donors who were hypertensive at the time of donation compared with normotensive donors. Hypertension was defined as blood pressure >140/90 mmHg or use of antihypertensive drugs. Adequate records available in 2131 donors revealed that 140 were hypertensive and 1991 were normotensive. Multivariable regression analyses were performed for overall and cardiovascular mortality. Hypertensive donors were significantly older (mean 57.7 vs. 46.9 years), more were males (44.3% vs. 41.5%), had higher body mass index (26.4 vs. 24.7) and lower estimated glomerular filtration rate (91.8 vs. 101.2 ml/min/1.73 m2 ). After a median observation time of 20.8 years (interquartile range 11) 71 hypertensive donors had died and 26 of the deaths were cardiovascular. Multivariable analysis did not suggest a generalizable association between hypertension and long-term overall mortality [hazard ratio (HR) 1.1, 95% confidence interval (CI) 0.9-1.5, P = 0.34] or cardiovascular mortality (HR 1.1, 95% CI 0.7-1.8, P = 0.55). These data may support the use of older healthy kidney donors with hypertension at donation.
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