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Hypertension and Kidney Function After Living Kidney Donation
Amit X Garg1,2,3,4,5,6, Jennifer B Arnold1, Meaghan S Cuerden1
1Lawson Health Research Institute and London Health Sciences, London, Ontario, Canada.
JAMA
|May 23, 2024
Summary
Living kidney donation does not increase hypertension or albuminuria risk. Donors experience a slower eGFR decline post-surgery but may have lower eGFR levels long-term.
Area of Science:
- Nephrology
- Transplantation
- Public Health
Background:
- Guidelines emphasize the need for robust evidence on long-term health outcomes for living kidney donors.
- Assessing post-donation risks is crucial for donor safety and informed consent.
Purpose of the Study:
- To compare the incidence of hypertension in living kidney donors versus matched nondonors.
- To evaluate differences in estimated glomerular filtration rate (eGFR) decline and albuminuria rates between donors and nondonors.
Main Methods:
- Prospective cohort study involving 924 living kidney donors and 396 nondonors, recruited between 2004 and 2014.
- Inverse probability of treatment weighting was used to balance baseline characteristics between groups.
- Follow-up assessments were conducted annually until November 2021, monitoring blood pressure, eGFR, and albuminuria.
Main Results:
- Hypertension incidence was similar between donors (17%) and nondonors (17%) after weighting (HR, 1.11; 95% CI, 0.75-1.66).
- Donors showed a slower mean eGFR decline (1.4 mL/min/1.73 m2/year less) but were more likely to have an eGFR between 30-60 mL/min/1.73 m2 (47% vs 5%).
- Albuminuria rates were comparable (15% in donors vs 11% in nondonors; HR, 1.46; 95% CI, 0.97-2.21).
Conclusions:
- Living kidney donation is not associated with significantly increased risks of hypertension or albuminuria compared to nondonors.
- While donors experience a slower eGFR decline post-nephrectomy, closer monitoring for reduced eGFR is warranted.
- The study provides valuable long-term health outcome data for living kidney donors.
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