Hypertension, cardiovascular disease and cause of death in Danish living kidney donors: matched cohort study

ObjectivesWe aimed to investigate the long-term absolute risk of hypertension and cardiovascular disease after kidney donation in living kidney donors.DesignLiving kidney donors were matched to 10 controls from the general population.SettingMultiple Danish national registries were used to identify living kidney donors from 1 January 1996 to 31 December 2017 nationwide.Participants1262 living kidney donors and 12 620 controls.Main outcome measuresHypertension, cardiovascular disease and diabetes.ResultsThe median age of living kidney donors was 52 (men 43%). Hypertension developed in 50 (4%) and 231 (1.8%) with a median follow-up of 7 years (IQR 3.3–12.1 years with a maximum follow-up of 22 years) and 6.9 years (IQR 3.2–11.7 years and maximum follow-up of 22 years) for donors and controls, respectively. The absolute risk of hypertension was 2.3% (95% CI 1.4% to 3.2%) and 1.2% (95% CI 1.0% to 1.4%), 4.2% (95% CI 2.8% to 5.7%) and 2.4% (95% CI 2.1% to 2.8%), 8.6% (95% CI 6.0% to 11.3%) and 3.3% (95% CI 2.8% to 3.8%) within 5, 10, 15 years for donors and controls, respectively. The ratio of the 10-year absolute risks for hypertension was 1.64 (95% CI 1.44 to 1.88) for donors compared with the controls. Two donors and four controls developed renal replacement therapy requiring end-stage renal disease during follow-up. The absolute risk of cardiovascular disease and diabetes was 7.3% (95% CI 5.7% to 9.5%) and 8.3% (95% CI 7.7% to 9.0%), 1.7% (95% CI 0.7% to 2.8%) and 3.2% (95% CI 2.7% to 3.6%) at 10 years for donors and controls, respectively.ConclusionsLiving kidney donors have an increased long-term absolute risk of hypertension compared with controls from the general population.

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Living Kidney Donors Who Develop Kidney Failure: Excerpts of Their Thoughts

American Journal of Nephrology ◽

10.1159/000446161 ◽

2016 ◽

Vol 43 (6) ◽

pp. 389-396 ◽

Cited By ~ 7

Author(s):

Colin M.E. Halverson ◽

Jackie Y. Wang ◽

Michael Poulson ◽

Jennifer Karlin ◽

Megan Crowley-Matoka ◽

...

Keyword(s):

Decision Making ◽

Living Donor ◽

Qualitative Interviews ◽

Kidney Donors ◽

Living Kidney Donors ◽

Physical Support ◽

Stage Renal Disease ◽

End Stage

Background: Psychosocial data about living kidney donors have been collected for almost 5 decades now. To date, however, no study has provided any psychosocial follow-up of donors who developed a serious health problem such as end-stage renal disease (ESRD). Methods: Donors who developed ESRD were invited to participate in a qualitative interview if they met one or both of the inclusion criteria: (1) developed ESRD within 10 years of donating and/or (2) lacked health insurance at the time of donation. We contacted 38 individuals who met these criteria, and 22 participated (58%). Two were subsequently excluded from analysis. Results: Twenty qualitative interviews were analyzed. Five findings are described: (1) donors describe the decision-making process as spontaneous and fast; (2) donors describe lack of appreciation for the need for post-donation self-care; (3) donors do not regret donating despite the adverse outcome; (4) donors advise future donors to have in place emotional and physical support post donation; and (5) donors appreciate the opportunity to tell their story from being a living donor to living with ESRD, which virtually all perceive as 2 separate unrelated events. Conclusions: Most donors are positive about their donation decision and experience and would donate again, despite developing ESRD themselves. They propose some important changes to the decision-making and informed-consent processes. Our data are reassuring regarding lack of donor regret, but highlight the need for living donor transplant programs to ensure that living donors understand their long-term risks and receive appropriate life-long follow-up care to minimize these risks.

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Long-term risks after kidney donation: how do we inform potential donors? A survey from DESCARTES and EKITA transplantation working groups

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab035 ◽

2021 ◽

Author(s):

Geir Mjøen ◽

Umberto Maggiore ◽

Nicos Kessaris ◽

Diederik Kimenai ◽

Bruno Watschinger ◽

...

Keyword(s):

Evaluation Process ◽

Kidney Donation ◽

Kidney Donors ◽

Living Kidney Donors ◽

Relative Risks ◽

Written Information ◽

The Difference ◽

Stage Renal Disease ◽

End Stage

Abstract Background Publications from the last decade have increased knowledge regarding long-term risks after kidney donation. We wanted to perform a survey to assess how transplant professionals in Europe inform potential kidney donors regarding long-term risks. The objectives of the survey were to determine how they inform donors and to what extent, and to evaluate the degree of variation. Methods All transplant professionals involved in the evaluation process were considered eligible, regardless of the type of profession. The survey was dispatched as a link to a web-based survey. The subjects included questions on demographics, the information policy of the respondent and the use of risk calculators, including the difference of relative and absolute risks and how the respondents themselves understood these risks. Results The main finding was a large variation in how often different long-term risks were discussed with the potential donors, i.e. from always to never. Eighty percent of respondents stated that they always discuss the risk of end-stage renal disease, while 56% of respondents stated that they always discuss the risk of preeclampsia. Twenty percent of respondents answered correctly regarding the relationship between absolute and relative risks for rare outcomes. Conclusions The use of written information and checklists should be encouraged. This may improve standardization regarding the information provided to potential living kidney donors in Europe. There is a need for information and education among European transplant professionals regarding long-term risks after kidney donation and how to interpret and present these risks.

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The Long-Term Incidence of Hospitalization for Ketoacidosis in Adults with Established T1D—A Prospective Cohort Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz003 ◽

2019 ◽

Vol 105 (1) ◽

pp. 231-241 ◽

Cited By ~ 1

Author(s):

Merlin Thomas ◽

Valma Harjutsalo ◽

Maija Feodoroff ◽

Carol Forsblom ◽

Daniel Gordin ◽

...

Keyword(s):

Diabetic Nephropathy ◽

General Population ◽

Density Lipoprotein ◽

Albumin Excretion Rate ◽

History Of ◽

Stage Renal Disease ◽

End Stage ◽

Incidence Of Hospitalization

Abstract Context The long-term natural history of diabetic ketoacidosis (DKA) and its risk factors are poorly understood. Objective To determine the long-term incidence and predictors of DKA in adults with longstanding type 1 diabetes (T1D). Design All hospitalizations and deaths due to DKA between 1996 and 2016 were identified in 4758 adults with T1D from the Finnish Diabetic Nephropathy Study (FinnDiane), and a cohort of 16 224 adults with T1D from the Finnish general population. Results Between 1996 and 2015, there were 1228 DKA events in the FinnDiane participants (1.4/100 person-years) and 4914 DKA events (1.8/100 person-years) in adults with T1D from the general population. The majority were hospitalized only once. There was a modest increase in the frequency of DKA in the FinnDiane over the follow-up (~2.4%/year [95% CI, 0.3–4.5%]; P = 0.03). Predictors of DKA were glucose control, CSII, smoking and alcohol consumption, and raised high-density lipoprotein cholesterol and triacylglycerides. Diabetic nephropathy and renal impairment were associated with DKA; patients with end-stage renal disease, macroalbuminuria, and microalbuminuria had 2.09-fol (95% CI, 1.40–3.12), 1.65-fold (95% CI, 1.23–2.19), and 0.87-fold (95% CI, 0.61–1.24) risk of DKA compared with patients with normal albumin excretion rate, respectively. Patients with an estimated glomerular filtration rate <60 mL/min/1.73 m2 were also more likely to be hospitalized for DKA (HR 1.71 [95% CI, 1.26–2.67]). Conclusions DKA remains a common cause of hospitalization in individuals with longstanding T1D. These data suggest that the goal to use SGLT2 inhibitors for their vasculo- and renoprotective actions may be problematic, as those most likely to benefit may also have the highest risk for DKA.

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Long-Term Kidney Outcomes in High BMI Living Kidney Donors: A Narrative Review

The Open Urology & Nephrology Journal ◽

10.2174/1874303x01710010041 ◽

2017 ◽

Vol 10 (1) ◽

pp. 41-51

Author(s):

Kalyani Murthy ◽

Hannah Caldwell ◽

Mary A. Simpson

Keyword(s):

Risk Factor ◽

Kidney Function ◽

Kidney Donor ◽

Living Kidney Donor ◽

Living Kidney Donors ◽

Pubmed Search ◽

Stage Renal Disease ◽

End Stage

Background: The shortage of transplantable organs has led to the expansion of the living kidney donor (LKD) pool to include overweight (body mass index [BMI] 25-30 kg/m2) and obese (BMI ≥30 kg/m2) donors. Higher BMI is a known risk factor for chronic kidney disease and progression to end-stage renal disease. Methods & Materials: We focused our review on long-term kidney-related outcomes (kidney function, hypertension, and proteinuria) among higher BMI LKDs. A PubMed search retrieved a total of 27 articles reporting on renal outcomes for obese LKDs. Of these, nine studies with ≥5 years of follow-up were selected for inclusion. Results: Five studies reported a decrease in kidney function at follow-up for higher BMI LKDs. Higher BMI was noted as a risk factor for hypertension in six studies. Proteinuria was reported in six studies, and a significant association was noted with higher BMI status in three. Conclusion: This review highlights the continued need for long-term documentation of kidney function and related outcomes in higher BMI LKDs.

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