Gestational Hypertension and Preeclampsia in Living Kidney Donors

Abstract

BACKGROUND Young women wishing to become living kidney donors frequently ask whether nephrectomy will affect their future pregnancies. METHODS We conducted a retrospective cohort study of living kidney donors involving 85 women (131 pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy nondonors from the general population (788 pregnancies after cohort entry). Kidney donations occurred between 1992 and 2009 in Ontario, Canada, with follow-up through linked health care databases until March 2013. Donors and nondonors were matched with respect to age, year of cohort entry, residency (urban or rural), income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry. The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia. Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes. RESULTS Gestational hypertension or preeclampsia was more common among living kidney donors than among nondonors (occurring in 15 of 131 pregnancies [11%] vs. 38 of 788 pregnancies [5%]; odds ratio for donors, 2.4; 95% confidence interval, 1.2 to 5.0; P = 0.01). Each component of the primary outcome was also more common among donors (odds ratio, 2.5 for gestational hypertension and 2.4 for preeclampsia). There were no significant differences between donors and nondonors with respect to rates of preterm birth (8% and 7%, respectively) or low birth weight (6% and 4%, respectively). There were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation. CONCLUSIONS Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney donors than in matched nondonors with similar indicators of baseline health. (Funded by the Canadian Institutes of Health Research and others.)

The Risk of Cardiovascular Disease Is Not Increasing Over Time Despite Aging and Higher Comorbidity Burden of Kidney Transplant Recipients

“…These databases have been used extensively for research on health outcomes and services including studies on cardiovascular disease. [11][12][13][14][15][16][17][18][19] The majority of the data were complete with the exception of income (0.3% missing), donor status (1% missing), primary cause of end-stage renal disease (ESRD) (8% missing), and race (10% missing).…”

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

“…It is possible that this risk may increase or accelerate after the donation of 1 kidney. In addition, women who donate a kidney are at increased risk of gestational hypertension and preeclampsia compared to nondonors (OR 2.4; 95% CI, 1.2-5.0) [449]. A cautious donor history in women must include obstetrical history.…”

Long-term medical risks to the living kidney donor

“…63 85 donors from Ontario, Canada, who underwent nephrectomy between 1992 and 2009, and among whom 131 pregnancies were reported, were compared with 510 healthy matched nondonors, among whom 788 pregnancies were reported. Donors and nondonors were matched according to risk factors for gest ational hypertension or pre-eclampsia: age, index date, rural versus urban residency, income, number of childbirths before the index date, and time to the first pregnancy after the index date.…”