Long-Term Consequences of Kidney Donation

[okarol]

Long-Term Consequences of Kidney Donation

New England Journal of Medicine
Volume 360:459-469      January 29, 2009      Number 5
Hassan N. Ibrahim, M.D., Robert Foley, M.B., B.S., LiPing Tan, M.D., Tyson Rogers, M.S., Robert F. Bailey, L.P.N., Hongfei Guo, Ph.D., Cynthia R. Gross, Ph.D., and Arthur J. Matas, M.D.

ABSTRACT

Background The long-term renal consequences of kidney donation by a living donor are attracting increased appropriate interest. The overall evidence suggests that living kidney donors have survival similar to that of nondonors and that their risk of end-stage renal disease (ESRD) is not increased. Previous studies have included relatively small numbers of donors and a brief follow-up period.

Methods We ascertained the vital status and lifetime risk of ESRD in 3698 kidney donors who donated kidneys during the period from 1963 through 2007; from 2003 through 2007, we also measured the glomerular filtration rate (GFR) and urinary albumin excretion and assessed the prevalence of hypertension, general health status, and quality of life in 255 donors.

Results The survival of kidney donors was similar to that of controls who were matched for age, sex, and race or ethnic group. ESRD developed in 11 donors, a rate of 180 cases per million persons per year, as compared with a rate of 268 per million per year in the general population. At a mean (±SD) of 12.2±9.2 years after donation, 85.5% of the subgroup of 255 donors had a GFR of 60 ml per minute per 1.73 m2 of body-surface area or higher, 32.1% had hypertension, and 12.7% had albuminuria. Older age and higher body-mass index, but not a longer time since donation, were associated with both a GFR that was lower than 60 ml per minute per 1.73 m2 and hypertension. A longer time since donation, however, was independently associated with albuminuria. Most donors had quality-of-life scores that were better than population norms, and the prevalence of coexisting conditions was similar to that among controls from the National Health and Nutrition Examination Survey (NHANES) who were matched for age, sex, race or ethnic group, and body-mass index.

Conclusions Survival and the risk of ESRD in carefully screened kidney donors appear to be similar to those in the general population. Most donors who were studied had a preserved GFR, normal albumin excretion, and an excellent quality of life.


Source Information

From the Departments of Medicine (H.N.I., L.T., T.R.) and Surgery (R.F.B., A.J.M.), the Division of Biostatistics and Office of Clinical Research (H.G.), and the College of Pharmacy and School of Nursing (C.R.G.), University of Minnesota; and the Chronic Disease Research Group (R.F.) — both in Minneapolis.

Address reprint requests to Dr. Ibrahim at the Division of Renal Diseases and Hypertension, University of Minnesota, Suite 353, 717 Delaware St., SE, Minneapolis, MN 55414, or at ibrah007@umn.edu.

Full Text of this Article (requires registration)

This article has been cited by other articles:

    * (2009). All you need to read in the other general journals. BMJ 338: b409-b409 [Full Text] 
    * Tan, J. C., Chertow, G. M. (2009). Cautious Optimism Concerning Long-Term Safety of Kidney Donation. NEJM 360: 522-523 [Full Text]   

[pelagia]

   Not sure how I missed this article posted by Karol, but it's really great news.  I came across this news piece on the study from Reuters.

http://www.reuters.com/article/healthNews/idUSTRE50R7WS20090128

Kidney donation appears safe in long term
Wed Jan 28, 2009 6:25pm EST
 
NEW YORK (Reuters Health) - Carefully selected kidney donors can expect to live just as long as non-donors do and to experience no significant decline in kidney function, according to a report in The New England Journal of Medicine.

Prior research has supported the safety of kidney donation and that donation has no effect on survival or function of the remaining kidney, lead author Dr. Hassan N. Ibrahim, from the University of Minnesota, Minneapolis, and colleagues explain. Still, most studies examining this topic have had relatively small sample sizes with only limited follow-up.

To examine long-term safety of kidney donation, Ibrahim's team analyzed data for 3,698 individuals who donated kidneys from 1963 to 2007. In 255 donors whose surgery was performed in 2003 or later, the researchers assessed the glomerular filtration rate (GFR), albuminuria, hypertension, general health status, and quality of life.

GFR is a measure of kidney function as expressed as the amount of blood filtered through the kidneys per minute, sometimes referred to as creatinine clearance. The normal range is typically 90 to 120 milliliters per minute (mL/min). Rates below 60 mL/min suggest kidney dysfunction and rates below 15 mL/min indicate kidney failure. Albuminuria, or albumin in the urine, is also an indication of kidney dysfunction.

No significant difference in survival was noted between donors and age-matched controls, the report indicates. Moreover, end-stage kidney disease was actually more common in controls than in donors: 268 vs. 180 cases per million per year.

During an average follow-up period of 12.2 years, 85.5 percent of the subjects in a subgroup analysis had a GFR of at least 60 mL/min/1.73 m of body-surface area. Hypertension and albuminuria were seen in 32.1 percent and 12.7 percent of subjects, respectively.

Older age and higher body mass index were predictive of hypertension and a reduced GFR on long-term follow-up. By contrast, a longer time since donation did not correlate with reduced GFR or hypertension, although it was linked with a decrease in albuminuria.

Quality of life was not adversely affected by donation and, in fact, donors usually had scores that were better than those in the general population. Having more than one illness occurred with comparable frequency in the donor and general populations.

Noting that the donors studied were relatively young and mostly white, editorialists Dr. Jane C. Tan and Dr. Glenn M. Chertow from Stanford University School of Medicine, Palo Alto, comment that further studies are needed to determine if the findings are applicable to older and nonwhite donors. Still, data from the current study "could encourage the expansion of the donor pool, but cautious optimism is warranted."