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Published on: June 16, 2014
Cardiovascular and Kidney Outcomes of Living Kidney Donors With Preexisting Hypertension: A Systematic Review and
Mariam Eldaba1, Sumaiya Ahmed2, Swapnil Hiremath2
1Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
Insights
Hypertensive living kidney donors face a higher mortality risk but show no increased risk for kidney failure or major adverse cardiovascular events (MACE). Further long-term studies are needed, especially for younger donors.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Increasing demand for kidney transplants leads to acceptance of living donors with hypertension.
- The long-term safety of using hypertensive individuals as living kidney donors is not well-established.
Purpose of the Study:
- To systematically review and meta-analyze cardiovascular and kidney outcomes in living kidney donors with and without pre-existing hypertension.
- To compare the risks of mortality, MACE, kidney failure, and reduced eGFR between hypertensive and normotensive living kidney donors.
Main Methods:
- Systematic search of major biomedical databases (MEDLINE, EMBASE, Cochrane CENTRAL, EBM) up to October 1, 2024.
- Inclusion of studies comparing living kidney donors with hypertension (exposure) to those without hypertension (comparator).
- Pooled risk differences (RD) for mortality, MACE, kidney failure, and estimated glomerular filtration rate (eGFR) ≤ 45 mL/min/1.73m².
Main Results:
- 17 studies included 4,881 hypertensive and 40,565 normotensive donors; median follow-up was 5.0 years.
- Hypertensive donors had a significantly higher risk of death (RD 40.0 per 1000 person years).
- No significant differences were found in kidney failure (RD 1.0), eGFR ≤ 45 mL/min/1.73m² (RD 20.0), or MACE (RD 3.0) between groups.
Conclusions:
- Hypertensive living kidney donors exhibit an increased risk of mortality compared to normotensive donors.
- No elevated risk for kidney failure, low eGFR, or MACE was observed in hypertensive donors.
- Long-term follow-up studies are recommended, particularly for younger hypertensive living kidney donors.
Background:
As the demand for living donor kidney transplantation increases, transplant programs have increasingly accepted hypertensive kidney donors. However, the safety of this practice remains unclear. This systematic review and meta-analysis aims to evaluate cardiovascular and kidney outcomes in living kidney donors with and without preexisting hypertension.
Methods:
We performed a systematic search across MEDLINE, EMBASE, Cochrane CENTRAL, and EBM databases up to 1 October 2024. The exposure group consisted of living kidney donors with hypertension, while the comparator group included those without hypertension. Primary outcomes included differences in survival, major adverse cardiovascular events (MACE), estimated glomerular filtration rate (eGFR) of 45 mL/min/1.73 m² or less, and development of kidney failure, defined as requiring dialysis or a transplant. Risk differences (proportion of participants experiencing the outcome in the hypertensive group minus the proportion in the normotensive group, risk difference) for mortality, MACE, kidney failure, and eGFR ≤ 45 mL/min/1.73 m² were pooled for synthesis.
Results:
Of the 983 studies screened, 17 were included, totaling 4,881 hypertensive and 40,565 normotensive kidney donors. The mean (SD) age at donation was 48.9 (18.1) years, with a median (IQR) follow-up of 5.0 (2.0-7.1) years. Hypertensive donors showed a significantly higher risk of death (RD 40.0 per 1,000 person years, 95% confidence interval (CI) 4.0, 70.0; P = 0.03), but no significant differences in kidney failure (RD 1.0 per 1,000 person years, 95% CI (0.3, 2.6); P = 0.13), eGFR ≤ 45 mL/min/1.73 m² (RD 20.0 per 1,000 person years, 95% CI, -90.0, 140.0; P = 0.69), or MACE (RD 3.0 per 1,000 person years, 95% CI, -90.0, 160.0; P = 0.58).
Conclusions:
This review suggests that hypertensive living kidney donors have a higher risk of death compared to normotensive donors, but no increased risk for kidney failure, low eGFR, or MACE. However, further long-term studies are needed, particularly for younger hypertensive donors.
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