Early Hypertension and Diabetes after Living Kidney Donation: A National Cohort Study

Background Living kidney donors have an increased risk of end-stage renal disease, with hypertension and diabetes as the predominant causes. In this study, we sought to better understand the timeline when these diseases occur, focusing on the early postdonation period. Methods We studied 41 260 living kidney donors in the US between 2008-2014 from the SRTR and modeled incidence rates and risk factors for hypertension and diabetes. Results At 6-months, 1-year, and 2-years postdonation, there were 74, 162, and 310 cases of hypertension per 10 000 donors. Donors who were older (per 10 years, aIRR 1.40, 95% CI 1.29-1.51), male (aIRR 1.31, 95% CI 1.14-1.50), had higher BMI (per 5 units, aIRR 1.29, 95% CI 1.17-1.43), and were related to their recipient (first degree relative, aIRR 1.28, 95% CI 1.08-1.52; spouse, aIRR 1.34, 95% CI 1.08-1.66) were more likely to develop hypertension, while donors who were Hispanic/Latino were less likely (aIRR 0.71, 95% CI 0.55-0.93). At 6-months, 1-year, and 2-years, there were 2, 6, and 15 cases of diabetes per 10 000 donors. Donors who were older (per 10 years, aIRR 1.42, 95% CI 1.11-1.82), had higher BMI (per 5 units, aIRR 1.52, 95% CI 1.04-2.21), and were Hispanic/Latino (aIRR 2.45, 95% CI 1.14-5.26) were more likely to develop diabetes. Conclusions In this national study, new-onset diabetes was rare, but 3% of donors developed hypertension within 2 years of nephrectomy. These findings reaffirm that disease pathways for kidney failure differ by donor phenotype and estimate the population most at-risk for later kidney failure. Received 9 May 2018. Revision received DD MMMM YYYY. Accepted 7 August 2018. Contact Information: Dorry Segev, M.D., Ph.D. Associate Vice Chair, Department of Surgery, Johns Hopkins Medical Institutions, 2000 E. Monument St. Baltimore, MD 21205, 410-502-6115 (tel) 410-614-2079 (fax), dorry@jhmi.edu AUTHORSHIP The individual contributions of each author are as follows: • CMH designed the study, analyzed and interpreted data, drafted and revised the article, and had final approval of this version; • SB designed the study, analyzed and interpreted data, revised the article, and had final approval of this version; • AT designed the study, analyzed and interpreted data, revised the article, and had final approval of this version; • MH designed the study, revised the article, and had final approval of this version; • CEH interpreted data, revised the article, and had final approval of this version; • SD interpreted data, revised the article, and had final approval of this version; • ADM designed the study, revised the article, and had final approval of this version; • JGW designed the study, drafted and revised the article, and had final approval of this version; • ABM designed the study, interpreted data, revised the article, and had final approval of this version; • KL designed the study, revised the article, and had final approval of this version; and • DS designed the study, interpreted data, revised the article, and had final approval of this version. DISCLOSURES The authors declare no conflicts of interest. The results presented in this paper have not been published previously in whole or part, except in abstract format. FUNDING This work was supported by grant numbers F32DK109662 (Holscher), K01DK114388 (Henderson), F32DK105600 (DiBrito), K01DK101677 (Massie), K24DK101828 (Segev), and R01DK096008 (Segev) from the National Institute of Diabetes and Digestive and Kidney Diseases, grant number F32AG053025 (Haugen) from the National Institute on Aging, and by an American College of Surgeons Resident Research Scholarship (Holscher). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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