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Early Hypertension and Diabetes After Living Kidney Donation

A National Cohort Study

Holscher, Courtenay M., MD1; Bae, Sunjae, MPH1; Thomas, Alvin G., MSPH1; Henderson, Macey L., JD, PhD1; Haugen, Christine E., MD1; DiBrito, Sandra R., MD1; Muzaale, Abimereki D., MD1; Garonzik Wang, Jacqueline M., MD, PhD1; Massie, Allan B., PhD1,2; Lentine, Krista L., MD, PhD3; Segev, Dorry L., MD, PhD1,2,4

doi: 10.1097/TP.0000000000002411
Original Clinical Science—General
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Background. Living kidney donors have an increased risk of end-stage renal disease, with hypertension and diabetes as the predominant causes. In this study, we sought to better understand the timeline when these diseases occur, focusing on the early postdonation period.

Methods. We studied 41 260 living kidney donors in the United States between 2008 and 2014 from the Scientific Registry of Transplant Recipients and modeled incidence rates and risk factors for hypertension and diabetes.

Results. At 6 months, 1 year, and 2 years postdonation, there were 74, 162, and 310 cases, respectively, of hypertension per 10 000 donors. Donors who were older (per 10 y, adjusted incidence rate ratio [aIRR], 1.40; 95% confidence interval [CI], 1.29-1.51), male (aIRR, 1.31; 95% CI, 1.14-1.50), had higher body mass index (per 5 units, aIRR, 1.29; 95% CI, 1.17-1.43), and were related to their recipient (first-degree relative: aIRR, 1.28; 95% CI, 1.08-1.52; spouse: aIRR, 1.34; 95% CI, 1.08-1.66) were more likely to develop hypertension, whereas donors who were Hispanic/Latino were less likely (aIRR, 0.71; 95% CI, 0.55-0.93). At 6 months, 1 year, and 2 years, there were 2, 6, and 15 cases of diabetes per 10 000 donors. Donors who were older (per 10 y: aIRR, 1.42; 95% CI, 1.11-1.82), had higher body mass index (per 5 units: aIRR, 1.52; 95% CI, 1.04-2.21), and were Hispanic/Latino (aIRR, 2.45; 95% CI, 1.14-5.26) were more likely to develop diabetes.

Conclusions. In this national study, new-onset diabetes was rare, but 3% of donors developed hypertension within 2 years of nephrectomy. These findings reaffirm that disease pathways for kidney failure differ by donor phenotype and estimate the population most at-risk for later kidney failure.

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 Saint Louis University Center for Abdominal Transplantation, St. Louis, MO.

4 Scientific Registry of Transplant Recipients, Minneapolis, MN.

Received 9 May 2018. Revision received 7 August 2018.

Accepted 7 August 2018.

This work was supported by grant numbers F32DK109662 (Holscher), K01DK114388 (Henderson), F32DK105600 (DiBrito), K01DK101677 (Massie), K24DK101828 (Segev), and R01DK096008 (Segev) from the National Institute of Diabetes and Digestive and Kidney Diseases, grant number F32AG053025 (Haugen) from the National Institute on Aging, and by an American College of Surgeons Resident Research Scholarship (Holscher).

The authors declare no conflicts of interest. The results presented in this paper have not been published previously in whole or part, except in abstract format.

C.M.H. designed the study, analyzed and interpreted data, drafted and revised the article, and had final approval of this version. S.B. designed the study, analyzed and interpreted data, revised the article, and had final approval of this version. A.T. designed the study, analyzed and interpreted data, revised the article, and had final approval of this version. M.H. designed the study, revised the article, and had final approval of this version. C.E.H. interpreted data, revised the article, and had final approval of this version. S.D. interpreted data, revised the article, and had final approval of this version. A.D.M. designed the study, revised the article, and had final approval of this version. J.G.W. designed the study, drafted and revised the article, and had final approval of this version. A.B.M. designed the study, interpreted data, revised the article, and had final approval of this version. K.L. designed the study, revised the article, and had final approval of this version. D.S. designed the study, interpreted data, revised the article, and had final approval of this version.

Correspondence: Dorry Segev, MD, PhD, Department of Surgery, Johns Hopkins Medical Institutions 2000 E. Monument St. Baltimore, MD 21205. (dorry@jhmi.edu).

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