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N Engl J Med. 2016 Feb 4;374(5):411-21. doi: 10.1056/NEJMoa1510491. Epub 2015 Nov 6.

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

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From the Division of Nephrology, Johns Hopkins University School of Medicine (M.E.G.), the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.E.G., Y.S., K.M., S.B., J.C.), and the Departments of Surgery and Epidemiology, Johns Hopkins University (E.K.H.C., D.L.S.) - all in Baltimore; the Division of Nephrology, Tufts Medical Center, Boston (A.S.L.); the Division of Nephrology, Geisinger Medical Center, Danville, PA (A.R.C.); the Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis (B.L.K.); Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center - both in Memphis (C.P.K.); the Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (G.N.N.); Medical Division, Maccabi Healthcare Services and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (V.S.); Centers for Abdominal Transplantation and Outcomes Research, Saint Louis University, St. Louis (K.L.L.); and the Departments of Medicine and Epidemiology and Biostatistics, Western University, and the Institute for Clinical Evaluative Sciences - both in London, ON, Canada (A.X.G.).



Evaluation of candidates to serve as living kidney donors 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 probable long-term risk of ESRD if that person does not donate a kidney.


We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States.


A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation.


Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).

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