title: Race, Relationship and Renal Diagnoses After Living Kidney Donation.
abstract: BACKGROUND
  In response to recent studies, a better understanding of the risks of renal complications among African American and biologically related living kidney donors is needed.
  
  
  METHODS
  We examined a database linking U.S. registry identifiers for living kidney donors (1987-2007) to billing claims from a private health insurer (2000-2007 claims) to identify renal condition diagnoses categorized by International Classification of Diseases 9th Revision coding. Cox regression with left and right censoring was used to estimate cumulative incidence of diagnoses after donation and associations (adjusted hazards ratios, aHR) with donor traits.
  
  
  RESULTS
  Among 4650 living donors, 13.1% were African American and 76.3% were white; 76.1% were first-degree relatives of their recipient. By 7 years post-donation, after adjustment for age and sex, greater proportions of African American compared with white donors had renal condition diagnoses: chronic kidney disease (12.6% vs 5.6%; aHR, 2.32; 95% confidence interval [95% CI], 1.48-3.62), proteinuria (5.7% vs 2.6%; aHR, 2.27; 95% CI, 1.32-3.89), nephrotic syndrome (1.3% vs 0.1%; aHR, 15.7; 95% CI, 2.97-83.0), and any renal condition (14.9% vs 9.0%; aHR, 1.72; 95% CI, 1.23-2.41). Although first-degree biological relationship to the recipient was not associated with renal risk, associations of African American race persisted for these conditions and included unspecified renal failure and reported disorders of kidney dysfunction after adjustment for biological donor-recipient relationship.
  
  
  CONCLUSIONS
  African Americans more commonly develop renal conditions after living kidney donation, independent of donor-recipient relationship. Continued research is needed to improve risk stratification for renal outcomes among African American living donors.
authors.affiliation: 1 Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO. 2 Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO. 3 Division of Nephrology, Western University, London, ON, Canada. 4 Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH. 5 Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 6 Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.forename: Janet E
authors.initials: JE
authors.lastname: Tuttle-Newhall
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D001741:Black or African American; D005190:Family; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D009404:Nephrotic Syndrome / Q000175:diagnosis / Q000208:ethnology* / Q000235:genetics; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000175:diagnosis / Q000208:ethnology* / Q000235:genetics; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000208:ethnology* / Q000235:genetics; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People