Hypertension in older living kidney donors associated with increased ESKD risk
Compared with living kidney donors aged 50 years or older without hypertension, those with hypertension had an elevated risk for ESKD, according to a recently published study.
“Among older living kidney donors, those with hypertension had had a three-to-six-fold higher risk of end-stage kidney disease, but not mortality, through 15 years post-donation,” Fawaz Al Ammary, MD, PhD, medical director of living donor kidney transplantation and assistant professor in the division of nephrology at Johns Hopkins University School of Medicine, told Healio/Nephrology. “However, the absolute risk of ESKD was small.”
Linking data from the Scientific Registry of Transplant Recipients to the Centers for Medicare & Medicaid and Social Security, researchers compared the risk for both ESKD and mortality between 24,533 donors with-and-without hypertension (2,265 with pre-donation hypertension; 82% white).
Hypertension was defined as documented use of antihypertensive therapy or a pre-donation systolic BP of 140 mm/Hg or greater or diastolic BP of 90 mm/Hg or greater.
Donors were followed for a median of 7.1 years.
During this time, 24 ESKD events and 252 deaths occurred.
Researchers found that the 15-year risk for ESKD was 0.8% for donors with hypertension and 0.2% for donors without hypertension (adjusted HR = 3.04; 95% CI, 1.28-7.22).
Further, ESKD risk was 6.21-fold higher for those using antihypertensive therapy than those who were not.
No significant association between donor hypertension and 15-year mortality was observed.
“Older age is not a barrier for kidney donation,” Al Ammary said. “However, for many older individuals, hypertension is common. Our findings improve the understanding of the risks of ESKD for an increasing number of medically complex living kidney donors. We plan to conduct additional studies in this area to advance the field of organ transplantation in light of the growing number of older individuals who may offer an important source of organs for living donation.”
In a related editorial, Kenneth A. Newell, MD, PhD, of Emory University School of Medicine, and Richard N. Formica, MD, of Yale University School of Medicine, wrote: “How do we expand access to the benefits of kidney transplantation and respect donor autonomy while balancing donor safety? The apparent answer lies in providing useful education about the risks associated with living kidney donation. These risks should not be general applying to the ‘average’ donor or capture a few of the ‘important’ donor characteristics but should include granular data that provide an individual considering living kidney donation an understanding of the risks, including ESKD, for an individual ‘like them.’ This approach is consistent with 2017 recommendations in the KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Risk assessment is central to these new guidelines, which focus on ‘individualized, quantitative estimates of donor risks.’” – by Melissa J. Webb
Disclosures: Al Ammary reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.