Blood pressure and renal function after kidney donation from hypertensive living donors.
BACKGROUND
Rising numbers of patients reaching end-stage kidney disease intensify the demand for expansion of the living-kidney-donor pool. On the basis of low risk in white donors with essential hypertension, our transplant center undertook a structured program of accepting hypertensive donors if kidney function and urine protein were normal. This study reports outcomes of hypertensive donors 1 year after kidney donation.


METHODS
We studied detailed measurements of blood pressure (oscillometric, hypertensive therapy nurse [RN], and ambulatory blood pressure monitoring [ABPM]), clinical, and renal characteristics (iothalamate glomerular filtration rate [GFR], urine protein, and microalbumin) in 148 living kidney donors before and 6 to 12 months after nephrectomy. Twenty-four were hypertensive (awake ABPM>135/85 mm Hg and clinic/RN BP>140/90 mm Hg) before donation.


RESULTS
After 282 days, normotensive donors had no change in awake ABPM pressure (pre 121 +/- 1/75 +/- 2 vs. post 120 +/- 1/ 5 +/- 1 mm Hg), whereas BP in hypertensive donors fell with both nonpharmacologic and drug therapy (pre 142 +/- 3/85 +/- 2 to post 132 +/- 2/80 +/- 1 mm Hg, P<.01). Hypertensive donors were older (53.4 vs. 41.4 years, P<.001) and had lower GFR after kidney donation (61 +/- 2 vs. 68 +/- 1 mL/min/1.73m, P<.01). After correction for age, no independent BP effect was evident for predicting GFR either before or after nephrectomy. Urine protein and microalbumin did not change in either group after donor nephrectomy.


CONCLUSIONS
Our results indicate that white subjects with moderate, essential hypertension and normal kidney function have no adverse effects regarding blood pressure, GFR, or urinary protein excretion during the first year after living kidney donation. Although further studies are essential to confirm long-term safety, these data suggest that selected hypertensive patients may be accepted for living kidney donation.
Textor
Stephen C
SC
Department of Medicine, Divisions of Nephrology and Hypertension, W9A, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. textor.stephen@mayo.edu
Taler
Sandra J
SJ
Driscoll
Nancy
N
Larson
Timothy S
TS
Gloor
James
J
Griffin
Matthew
M
Cosio
Fernando
F
Schwab
Thomas
T
Prieto
Mikel
M
Nyberg
Scott
S
Ishitani
Michael
M
Stegall
Mark
M
D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000502:physiology*; D019520:Living Donors / Q000706:statistics & numerical data*; D009392:Nephrectomy; D012189:Retrospective Studies; D012907:Smoking; D013997:Time Factors; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome