Living Kidney Donation and Hypertension

A substantial proportion of living kidney donor candidates are hypertensive or diagnosed with hypertension during the evaluation process. Furthermore, many donors develop hypertension after nephrectomy as they age, similar to nondonors. In this article, we review the data available from the general population and donor cohorts relevant to the risk of development of hypertension after donation, and the risk associated with pre-existing hypertension. Large long-term data show that treatment and control of hypertension mitigate the cardiovascular mortality risk associated with hypertension. Given the bidirectional relationship between hypertension and chronic kidney disease, whether milder forms of hypertension increase the risk of kidney disease is less clear; however, the absolute risk appears to be low. While retrospective studies provide conflicting results, several prospective studies with well-selected nondonor controls demonstrate no longitudinal differences in blood pressure. Data on donors with pre-existing hypertension, albeit limited and heterogeneous, are overall reassuring. We provide an overview of the major guidelines currently used in the evaluation of hypertensive kidney donors, and also outline our center's approach to these candidates. A major limitation of the available body of literature is the paucity of studies focusing on minority populations, including Blacks and medically complex donors with multiple additional risk factors. Ongoing investigation using updated blood pressure measurement techniques, definition, and treatment guidelines and including medically complex and minority populations are needed.