Increased long‐term risk for hypertension in kidney donors – a retrospective cohort study

Haugen, Anders J; Hallan, Stein; Langberg, Nina E; Dahle, Dag Olav; Pihlstrøm, Hege; Birkeland, Kåre I.; Reisæter, Anna Varberg; Midtvedt, Karsten; Hartmann, Anders; Holdaas, Hallvard; Mjøen, Geir

doi:10.1111/tri.13576

Cited by 19 publications

(13 citation statements)

References 24 publications

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“…Consequently, when we observe this association in kidney donors, it strengthens the hypothesis of a causal relationship between reduced GFR and cardiovascular disease. Other studies finding an increased risk of hypertension and cardiovascular mortality after donor nephrectomy also support this relationship [ 3 , 4 , 20 ]. After controlling for confounders that also represent potential cardiovascular risk factors (baseline BMI, smoking and SBP), kidney donation was a significant risk factor for ischaemic heart disease.…”

Section: Discussionmentioning

confidence: 57%

“…The donor and control stratification are presented in Figure 2 . Details of the study design have previously been described [ 3 ].…”

Section: Methodsmentioning

confidence: 99%

“…A known consequence following a donor nephrectomy is an immediate reduction in glomerular filtration rate (GFR), followed by a slow compensatory increase before GFR slowly declines [ 2 ]. Previous meta-analyses and several studies [ 3–7 ] suggest that living donors have increased blood pressure (BP) and proteinuria after donation. Proteinuria, hypertension and reduced renal function are all risk factors for the development of cardiovascular disease [ 8–12 ].…”

Section: Introductionmentioning

confidence: 99%

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Increased risk of ischaemic heart disease after kidney donation

Haugen

Hallan

Langberg

et al. 2021

Nephrology Dialysis Transplantation

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Background Previous reports suggest increased risk of hypertension and cardiovascular mortality after kidney donation. In this study we investigate occurrence of ischemic heart disease and cerebrovascular disease, diabetes and cancer in live kidney donors compared with healthy controls eligible for donation. Methods Different diagnoses were assessed in 1029 kidney donors and 16084 controls. The diagnoses at follow-up were self-reported for the controls and registered by a physician for the donors. Stratified logistic regression was used to estimate associations with various disease outcomes, adjusted for gender, age at follow up, smoking at baseline, body mass index at baseline, systolic blood pressure at baseline and time since donation. Results The mean (standard deviation) observation time was 11.3 (8.1) years for donors versus 16.4 (5.7) years for controls. Age at follow-up was 56.1 (12.4) years in donors vs 53.5 (11.1) years in controls and 44% of donors were males vs 39.3% in the controls. At follow up 35 (3.5%) of the donors had been diagnosed with ischemic heart disease versus 267 (1.7%) of the controls. Adjusted odds ratio for ischemic heart disease was 1.64 (confidence interval 1.10-2.43, P = 0.01) in donors compared with controls. There were no significant differences for the risks of cerebrovascular disease, diabetes or cancer. Conclusions During long-term follow-up of kidney donors we find an increased risk of ischemic heart disease compared to healthy controls. This information may be important in the follow-up and selection process of living kidney donors.

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Section: Discussionmentioning

confidence: 57%

“…The donor and control stratification are presented in Figure 2 . Details of the study design have previously been described [ 3 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Increased risk of ischaemic heart disease after kidney donation

Haugen

Hallan

Langberg

et al. 2021

Nephrology Dialysis Transplantation

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“… 11 An increased risk of hypertension in donors relative to non-donors has been reported in several studies. 11 , 13 - 17 , 33 The true risk for hypertension remains unclear, however, because studies have not defined hypertension uniformly, non-donors have not undergone the same health screening as donors, and follow-up in donors and non-donors has been dissimilar and incomplete. A better understanding of this risk is central to donor selection and consent.…”

Section: Discussionmentioning

confidence: 99%

The Living Kidney Donor Safety Study: Protocol of a Prospective Cohort Study

Garg

Arnold

Cuerden

et al. 2022

Can J Kidney Health Dis

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Background: Living kidney donation is considered generally safe in healthy individuals; however, there is a need to better understand the long-term effects of donation on blood pressure and kidney function. Objectives: To determine the risk of hypertension in healthy, normotensive adults who donate a kidney compared with healthy, normotensive non-donors with similar indicators of baseline health. We will also compare the 2 groups on the rate of decline in kidney function, the risk of albuminuria, and changes in health-related quality of life. Design, Participants, and Setting: Prospective cohort study of 1042 living kidney donors recruited before surgery from 17 transplant centers (12 in Canada and 5 in Australia) between 2004 and 2014. Non-donor participants (n = 396) included relatives or friends of the donor, or donor candidates who were ineligible to donate due to blood group or cross-match incompatibility. Follow-up will continue until 2021, and the main analysis will be performed in 2022. The anticipated median (25th, 75th percentile, maximum) follow-up time after donation is 7 years (6, 8, 15). Measurements: Donors and non-donors completed the same schedule of measurements at baseline and follow-up (non-donors were assigned a simulated nephrectomy date). Annual measurements were obtained for blood pressure, estimated glomerular filtration rate (eGFR), albuminuria, patient-reported health-related quality of life, and general health. Outcomes: Incident hypertension (a systolic/diastolic blood pressure ≥ 140/90 mm Hg or receipt of anti-hypertensive medication) will be adjudicated by a physician blinded to the participant’s donation status. We will assess the rate of change in eGFR starting from 12 months after the nephrectomy date and the proportion who develop an albumin-to-creatinine ratio ≥3 mg/mmol (≥30 mg/g) in follow-up. Health-related quality of life will be assessed using the 36-item RAND health survey and the Beck Anxiety and Depression inventories. Limitations: Donation-attributable hypertension may not manifest until decades after donation. Conclusion: This prospective cohort study will estimate the attributable risk of hypertension and other health outcomes after living kidney donation.

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“…Key studies published after 2018 are summarized in Table 2 and report varying results. Some have reported a higher incidence of hypertension compared with controls [ 17 , 39 , 41 ]. Munch et al .…”

Section: Hypertensionmentioning

confidence: 99%

Risk for subsequent hypertension and cardiovascular disease after living kidney donation: is it clinically relevant?

Ferro

Townend

2021

Clinical Kidney Journal

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The first successful live donor kidney transplant was performed in 1954. Receiving a kidney transplant from a live kidney donor remains the best option for increasing both life expectancy and quality of life in patients with end-stage kidney disease. However, ever since 1954 there have been multiple questions raised on the ethics of live kidney donation in terms of negative impacts on donor life expectancy. Given the close relationship between reduced kidney function in patients with chronic kidney disease and hypertension, cardiovascular disease, and cardiovascular mortality, information on the impact of kidney donation on these is particularly relevant. In this article we review the existing evidence, focusing on the more recent studies, on the impact of kidney donation on all-cause mortality, cardiovascular mortality, cardiovascular disease, hypertension as well as markers of cardiovascular damage including arterial stiffness and uraemic cardiomyopathy. We also discuss the similarities and differences between the pathological reduction in renal function that occurs in chronic kidney disease with the reduction in renal function that occurs because of a donor nephrectomy. Kidney donors perform an altruistic act that benefits individual patients as well as the wider society. They deserve to have high quality evidence on which to make informed decisions.

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Increased long‐term risk for hypertension in kidney donors – a retrospective cohort study

Cited by 19 publications

References 24 publications

Increased risk of ischaemic heart disease after kidney donation

Increased risk of ischaemic heart disease after kidney donation

The Living Kidney Donor Safety Study: Protocol of a Prospective Cohort Study

Risk for subsequent hypertension and cardiovascular disease after living kidney donation: is it clinically relevant?

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