title: Obesity increases the risk of end-stage renal disease among living kidney donors.
abstract: Determining candidacy for live kidney donation among obese individuals remains challenging. Among healthy non-donors, body mass index (BMI) above 30 is associated with a 16% increase in risk of end-stage renal disease (ESRD). However, the impact on the ESRD risk attributable to donation and living with only one kidney remains unknown. Here we studied the risk of ESRD associated with obesity at the time of donation among 119 769 live kidney donors in the United States. Maximum follow-up was 20 years. Obese (BMI above 30) live kidney donors were more likely male, African American, and had higher blood pressure. Estimated risk of ESRD 20 years after donation was 93.9 per 10 000 for obese; significantly greater than the 39.7 per 10 000 for non-obese live kidney donors. Adjusted for age, sex, ethnicity, blood pressure, baseline estimated glomerular filtration rate, and relationship to recipient, obese live kidney donors had a significant 86% increased risk of ESRD compared to their non-obese counterparts (adjusted hazard ratio 1.86; 95% confidence interval 1.05-3.30). For each unit increase in BMI above 27 kg/m2there was an associated significant 7% increase in ESRD risk (1.07, 1.02-1.12). The impact of obesity on ESRD risk was similar for male and female donors, African American and Caucasian donors, and across the baseline estimated glomerular filtration rate spectrum. These findings may help to inform selection criteria and discussions with persons considering living kidney donation.
authors.affiliation: University of Alabama at Birmingham School of Medicine, Comprehensive Transplant Institute, Birmingham, Alabama, USA. Electronic address: jlocke@uabmc.edu.
authors.forename: Jayme E
authors.initials: JE
authors.lastname: Locke
authors.affiliation: University of Alabama at Birmingham School of Medicine, Comprehensive Transplant Institute, Birmingham, Alabama, USA.
authors.forename: Rhiannon D
authors.initials: RD
authors.lastname: Reed
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Allan
authors.initials: A
authors.lastname: Massie
authors.affiliation: University of Alabama at Birmingham School of Medicine, Comprehensive Transplant Institute, Birmingham, Alabama, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: MacLennan
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Sawinski
authors.affiliation: University of Alabama at Birmingham School of Medicine, Comprehensive Transplant Institute, Birmingham, Alabama, USA.
authors.forename: Vineeta
authors.initials: V
authors.lastname: Kumar
authors.affiliation: University of Alabama at Birmingham School of Medicine, Comprehensive Transplant Institute, Birmingham, Alabama, USA.
authors.forename: Shikha
authors.initials: S
authors.lastname: Mehta
authors.affiliation: University of Alabama at Birmingham School of Medicine, Comprehensive Transplant Institute, Birmingham, Alabama, USA.
authors.forename: Roslyn B
authors.initials: RB
authors.lastname: Mannon
authors.affiliation: University of Alabama at Birmingham School of Medicine, Comprehensive Transplant Institute, Birmingham, Alabama, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gaston
authors.affiliation: University of Alabama at Birmingham School of Medicine, Comprehensive Transplant Institute, Birmingham, Alabama, USA.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D001741:Black or African American; D015992:Body Mass Index; D046148:Donor Selection; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000401:mortality; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People
keywords: end-stage renal disease (ESRD); kidney transplantation; living kidney donation; obesity