Long-term effects of living kidney donation on renal function, blood pressure and survival

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M.H. de Borst, M.F.C. de Jong, S.J Bakker, R.T. Gansevoort, G.J Navis, S.P. Berger

Chair(s): dr. Dennis A. Hesselink, internist-nefroloog, Erasmus MC & dr. Marieke Roemeling, internist i.o., UMC Groningen

Wednesday 9 march 2016

15:50 - 16:00h at Zaal 1 & 2

Categories: Parallelsessie (klinisch)

Parallel session: Parallelsessie V - Klinisch

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Introduction:
Studies addressing the impact of kidney donation on clinical outcomes have yielded conflicting results, at least in part due to inadequate matching with controls.

Methods:
We analyzed data from 610 living kidney donors and matched controls derived from a general population-based cohort (PREVEND), who did not have diabetes or micro- or macroalbuminuria at baseline (n=7296). We performed 1:1 propensity matching by age, sex, body mass index (BMI), systolic blood pressure (BP), antihypertensive use, and eGFR at baseline. We also analyzed measured GFR (mGFR) by iothalamate clearance before donation (n=432), and at 3 months (n=406), 5 years (n=192) and 10 years (n=58) after donation.

Results:
At baseline, donors were 51±10 yrs old, 49% were men, 16% used antihypertensive drugs, systolic BP was 129±15 mmHg, BMI was 25±6 kg/m2 and eGFR was 89±15 ml/min/1.73 m2; these parameters were highly similar in non-donors (all P>0.05). During follow-up for 10.3 [4.5-10.8] years, 7 donors and 56 non-donors died. The all-cause mortality risk in donors was lower than in matched non-donors (hazard ratio 0.27 [95% CI 0.12-0.60], P=0.001). This association remained similar after adjustment for age, sex, BMI, systolic BP, and eGFR. In a subgroup of individuals with 4-year follow-up data (197 donors and 483 non-donors), BMI (27±4 vs 26±4 kg/m2), BP (127±16 vs 129±20 mmHg) and antihypertensive use (24% vs 20%) were similar among both groups (all P>0.05), whereas eGFR was lower in donors (67±14 mL/min/1.73 m2) than in non-donors (86±17 mL/min/1.73 m2). mGFR was 116±22 mL/min before donation, was reduced to 73±13 mL/min (P<0.001) at 3 mo post-donation and stabilized at 5 yrs (80±19 mL/min) and 10 yrs (77±16) after donation. None of the donors developed an mGFR

Conclusion:
Live kidney donation is a safe procedure in carefully selected patients and seems associated with a lower all-cause mortality risk compared with matched individuals in the general population.