Outcomes of Kidney Donors With Impaired Fasting Glucose

Abstract

Background. Many kidney donor candidates with impaired fasting glucose (IFG) and all candidates with diabetes are currently excluded from kidney donation, fearing the development of an accelerated course of diabetic kidney disease in the remaining kidney. Methods. We studied mortality, proteinuria, and end-stage kidney disease (ESKD) in 8280 donors who donated between 1963 and 2007 according to donation fasting plasma glucose (FPG): <100 mg/dL (n = 6204), 100-125 mg/dL (n = 1826), and ≥126 mg/dL (n = 250). Results. Donors with IFG and those with FPG ≥126 mg/dL were older, less likely to be non-Hispanic White, had a higher body mass index, and were more likely to be related to their recipient. After 15.7 ± 10.5 y from donation to study close, 4.4% died, 29.4% developed hypertension, 13.8% developed proteinuria, and 41 (0.5%) developed ESKD. In both the logistic and Cox models, IFG was associated with a higher diabetes risk (adjusted hazard ratio [aHR], 1.65; 95% confidence interval [CI], 1.18-2.30) and hypertension (aHR, 1.35; 95% CI, 1.10-1.65; P = 0.003 for both), but not higher risk of proteinuria or ESKD. The multivariable risk of mortality in donors with ≥126 mg/dL was higher than the 2 other groups, but risks of proteinuria, cardiovascular disease, and reduced estimated glomerular filtration rate were similar to those with FPG <126 mg/dL. Three cases of ESKD developed in the 250 donors with FPG ≥126 mg/dL at 18.6 ± 10.3 y after donation (aHR, 5.36; 95% CI, 1.0-27.01; P = 0.04). Conclusions. Donors with IFG and the majority of donors with ≥126 mg/dL do well and perhaps should not be routinely excluded from donation.

Accepting Living Kidney Donors with Preexisting Diabetes Mellitus

“…For context, over a mean follow-up of 15.7 years, a study of 8,280 donors, including 1,826 with impaired fasting glucose at the time of donation and 6,204 without, found similar survival and rates of kidney failure among donors with and without impaired fasting glucose. [5] Since diabetes mellitus is a major cause of kidney failure, accepting diabetic living kidney donors with additional risk factors raises substantial clinical concerns and should be approached with caution. Uncontrolled hypertension (HTN) is a significant and independent risk factor for the development of chronic kidney disease (CKD), kidney failure and graft failure in transplant recipients.…”

Intermediate Renal Outcomes, Kidney Failure, and Mortality in Obese Kidney Donors

“…21 Although preliminary evidence suggests donors with impaired glucose tolerance, and even diabetes, at the time of donation have an overall risk of ESKD that is comparable to what is observed in patients with diabetes with full complement of nephrons, the length of follow-up of these studies is too short to draw strong recommendations and more research is needed. 27,28 The concern about obese donor candidates' higher likelihood of developing hypertension has also been suggested as another rationale for declining obese donor candidates. Roughly, a third of kidney donors develop hypertension after donation and the overall risk of ESKD in older (.50 years) hypertensive donors is ,1%.…”

Diabetes-free survival among living kidney donors and non-donors with obesity: A longitudinal cohort study

“…Our understanding of the impact of kidney donation on lifetime ESKD development-the guiding principle of donor selection-remains limited as most studies report mean follow-up of 20 years or less [17][18][19]. Given the concern for kidney disease development or progression in the setting of diabetes and uninephrectomy [20][21][22], the need to evaluate intermediate outcomes of ESKD, such as diabetes development among LKDs with obesity, is critical to guide donation practices and prioritize LKD safety.…”