Patterns of End-Stage Renal Disease Caused by Diabetes, Hypertension, and Glomerulonephritis in Live Kidney Donors.
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]1.31.72.3[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 (IRR2.37.725.2and1.42.64.6, respectively). These time-dependent patterns were not seen with GN-ESRD (IRR0.40.71.2). 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.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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Anjum
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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0000-0002-3287-6061
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Muzaale
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
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Massie
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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0000-0003-0098-8816
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Bae
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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Luo
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.|Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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Grams
Division of Nephrology, Saint Louis University School of Medicine, St. Louis, MO.
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Lentine
Division of Nephrology, Departments of Medicine, Epidemiology, and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.
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Garg
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
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Segev
D000293:Adolescent; D000328:Adult; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000150:complications*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000209:etiology*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult
clinical research/practice; donors and donation: donor follow-up; donors and donation: living; kidney transplantation/nephrology