Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate

Abstract

Background Evaluation of candidates for living kidney donation relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person’s likely long-term risk of ESRD in the absence of donation. Methods We used meta-analyzed risk associations from 7 general population cohorts, calibrated to US population-level incidence of ESRD and mortality, to project the estimated long-term incidence of ESRD in the absence of donation according to 10 demographic and health characteristics. We then compared 15-year projections to observed risk among recent US living kidney donors (N=52,998). Results There were 4,933,314 participants followed a median of 4 to 16 years. For a 40-year-old person with health characteristics similar to age-matched kidney donors, the 15-year ESRD risk projections in the absence of donation varied by race and sex: 0.24%, 0.15%, 0.06%, and 0.04% in black men, black women, white men, and white women. Risk projections were higher in the presence of lower estimated glomerular filtration rate, higher albuminuria, hypertension, smoking, diabetes, and obesity. In the model-based lifetime projections, ESRD risk was highest at younger age, particularly among African Americans. Risk projections in the absence of donation were 3.5–5.3-fold lower than 15-year observed risk post-donation in US kidney donors. Conclusions We suggest multiple health characteristics be considered together to estimate long-term ESRD risk for living kidney donor candidates.

Lifetime risk of renal replacement therapy in Europe: a population-based study using data from the ERA-EDTA Registry

“…[12] The latter results were recently used as a reference level in a model predicting the lifetime risk of RRT in people who were potential kidney donors, but did not donate a kidney. [2] As the lifetime risk in the European general population is substantially lower than in the USA, the reference level in potential living kidney donors is also likely to be lower. Consequently, the risk prediction model that was developed by the CKD Prognosis Consortium for people in the USA, Canada and Israel needs to be recalibrated and validated before implementation in Europe.…”

“…Recently the Chronic Kidney Disease (CKD) Prognosis Consortium published such a risk prediction model for the lifetime risk of ESRD in potential kidney donors. [2] This model was based on populations from Canada, the USA and Israel, [2,3] and may not be generalizable to European populations. For example, the incidence of renal replacement therapy (RRT), defined as haemodialysis, peritoneal dialysis and kidney transplantation, in the United States is almost two times higher than that of Belgium and Greece, both countries with the highest incidence of RRT in Europe.…”

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“…14 Hypertension is present in 30% of the general population, and the prevalence increases with age; some studies report that it is present in 2% of living donors at the time of donation (we observed a rate of 5%) and develops in up to 40% of donors over time. 15,16 Garg and associates reported a 10-year hypertension rate of 16% postdonation, about 5% higher than in the control population. 16 The literature suggests that transplant programs generally exclude donors with a BMI > 35 kg/m², and 10% of programs exclude donors with a BMI > 30 kg/m².…”

Ethical Issues in Organ Procurement and Transplantation

“…"nd on what basis does the center make its decision other than personal feeling of the selection team. Grams et al [18] have recently created a model that can help to predict the risk of eventual renal failure in potential kidney donors. "ut there will always be some uncertainty in donor selection.…”