Abstract
Living kidney donation represents the optimal renal replacement therapy, but recent data suggest an increased long-term renal risk for the donor. Here, we evaluated the risk for reduced estimated glomerular filtration rate (eGFR), death, and major cardiovascular events such as nonfatal myocardial infarction or cerebrovascular event including TIA (transient ischemic attack) and stroke in 225 donors, who underwent pre-donation examinations and live donor nephrectomy between 1985 and 2014 at our center. The median follow-up time was 8.7 years (1.0–29.1). In multivariate analysis, age and arterial hypertension at baseline were significantly associated with a higher risk of adverse renal outcomes, such as (1) eGFR <60 mL/min/1.73 m2 (age per year: HR (hazard ratio) 1.05, 95% confidence interval (CI) 1.03–1.08, hypertension: HR 2.25, 95% CI 1.22–3.98), (2) eGFR <60 mL/min/1.73 m2 and a decrease of ≥40% from baseline (age: HR 1.08, 95% CI 1.03–1.13, hypertension: HR 4.22, 95% CI 1.72–10.36), and (3) eGFR <45 mL/min/1.73 m2 (age: HR 1.12, 95% CI 1.05–1.20, hypertension: HR 5.06, 95% CI 1.49–17.22). In addition, eGFR at time of donation (per mL/min/1.73 m2) was associated with a lower risk of (1) eGFR <60 mL/min/1.73 m2 (HR 0.98, 95% CI 0.97–1.00) and (2) eGFR <45 mL/min/1.73 m2 (HR 0.95, 95% CI 0.90–1.00). Age was the only significant predictor for death or major cardiovascular event (HR 1.08, 95% CI 1.01–1.16). In conclusion, arterial hypertension, lower eGFR, and age at the time of donation are strong predictors for adverse renal outcomes in living kidney donors.
Highlights
Living kidney donation is the optimal renal replacement therapy for patients with end-stage kidney disease in terms of life expectancy, renal function, and quality of life [1,2,3]
Two recent large cohort studies reported a higher risk of end-stage renal disease (ESRD) among donors compared with healthy nondonors [5,6]
The findings of our study suggest that the presence of arterial hypertension at the time of living kidney donation, irrespective of the use of antihypertensive agents, represents a long-term risk factor for new-onset chronic kidney disease post-donation
Summary
Living kidney donation is the optimal renal replacement therapy for patients with end-stage kidney disease in terms of life expectancy, renal function, and quality of life [1,2,3]. Recent data suggest an increased long-term renal risk for the donor [4]. Two recent large cohort studies reported a higher risk of end-stage renal disease (ESRD) among donors compared with healthy nondonors [5,6]. In the Swiss Organ Living-Donor Health Registry, occurrence of albuminuria increased from 4.8% to 10.4% over a follow-up period of 10 years. At last follow-up, the rate of microalbuminuria was significantly higher in donors who were hypertensive at the time of donation as compared to normotensive donors (16.6% vs 6.0%, p = 0.03). Urinary albumin excretion rate at the time of donation was not dependent on the presence of hypertension but was only associated with donor age [8]
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