Racial variation in medical outcomes among living kidney donors.
BACKGROUND
Data regarding health outcomes among living kidney donors are lacking, especially among nonwhite persons.


METHODS
We linked identifiers from the Organ Procurement and Transplantation Network (OPTN) with administrative data of a private U.S. health insurer and performed a retrospective study of 4650 persons who had been living kidney donors from October 1987 through July 2007 and who had post-donation nephrectomy benefits with this insurer at some point from 2000 through 2007. We ascertained post-nephrectomy medical diagnoses and conditions requiring medical treatment from billing claims. Cox regression analyses with left and right censoring to account for observed periods of insurance benefits were used to estimate absolute prevalence and prevalence ratios for diagnoses after nephrectomy. We then compared prevalence patterns with those in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) for the general population.


RESULTS
Among the donors, 76.3% were white, 13.1% black, 8.2% Hispanic, and 2.4% another race or ethnic group. The median time from donation to the end of insurance benefits was 7.7 years. After kidney donation, black donors, as compared with white donors, had an increased risk of hypertension (adjusted hazard ratio, 1.52; 95% confidence interval [CI], 1.23 to 1.88), diabetes mellitus requiring drug therapy (adjusted hazard ratio, 2.31; 95% CI, 1.33 to 3.98), and chronic kidney disease (adjusted hazard ratio, 2.32; 95% CI, 1.48 to 3.62); findings were similar for Hispanic donors. The absolute prevalence of diabetes among all donors did not exceed that in the general population, but the prevalence of hypertension exceeded NHANES estimates in some subgroups. End-stage renal disease was identified in less than 1% of donors but was more common among black donors than among white donors.


CONCLUSIONS
As in the general U.S. population, racial disparities in medical conditions occur among living kidney donors. Increased attention to health outcomes among demographically diverse kidney donors is needed. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.)
Lentine
Krista L
KL
Center for Outcomes Research and the Division of Nephrology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA. lentinek@slu.edu
Schnitzler
Mark A
MA
Xiao
Huiling
H
Saab
Georges
G
Salvalaggio
Paolo R
PR
Axelrod
David
D
Davis
Connie L
CL
Abbott
Kevin C
KC
Brennan
Daniel C
DC
D000328:Adult; D001741:Black or African American; D002908:Chronic Disease; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000208:ethnology*; D007674:Kidney Diseases / Q000208:ethnology*; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000601:surgery; D016030:Kidney Transplantation / Q000208:ethnology*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People
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