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Am J Transplant. 2016 Dec;16(12):3540-3547. doi: 10.1111/ajt.13917. Epub 2016 Jul 12.

Patterns of End-Stage Renal Disease Caused by Diabetes, Hypertension, and Glomerulonephritis in Live Kidney Donors.

Author information

1
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
2
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
3
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
4
Division of Nephrology, Saint Louis University School of Medicine, St. Louis, MO.
5
Division of Nephrology, Departments of Medicine, Epidemiology, and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.

Abstract

Inferences about late risk of end-stage renal disease (ESRD) in live kidney donors have been extrapolated from studies averaging <10 years of follow-up. Because early (<10 years) and late (≥10 years) postdonation ESRD may differ by causal mechanism, it is possible that extrapolations are misleading. To better understand postdonation ESRD, we studied patterns of common etiologies including diabetes, hypertension and glomerulonephritis (GN; as reported by providers) using donor registry data linked to ESRD registry data. Overall, 125 427 donors were observed for a median of 11.0 years (interquartile range 5.3-15.7 years; maximum 25 years). The cumulative incidence of ESRD increased from 10 events per 10 000 at 10 years after donation to 85 events per 10 000 at 25 years after donation (late vs. early ESRD, adjusted for age, race and sex: incidence rate ratio [IRR] 1.3 1.72.3 [subscripts are 95% confidence intervals]). Early postdonation ESRD was predominantly reported as GN-ESRD; however, late postdonation ESRD was more frequently reported as diabetic ESRD and hypertensive ESRD (IRR 2.3 7.725.2 and 1.4 2.64.6 , respectively). These time-dependent patterns were not seen with GN-ESRD (IRR 0.4 0.71.2 ). Because ESRD in live kidney donors has traditionally been reported in studies averaging <10 years of follow-up, our findings suggest caution in extrapolating such results over much longer intervals.

KEYWORDS:

clinical research/practice; donors and donation: donor follow-up; donors and donation: living; kidney transplantation/nephrology

PMID:
27287605
PMCID:
PMC6116527
DOI:
10.1111/ajt.13917
[Indexed for MEDLINE]
Free PMC Article

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