Risk to Donors (Not too bad)

[obsidianom]

By Megan Brooks
February 11, 2014

New YORK (Reuters Health) - Healthy kidney donors face a very small increased lifetime risk of end-stage renal disease (ESRD), compared with healthy nondonors, a new study finds.

"Donating a kidney is a very personal decision, and isn't right for everyone, but our study supports the current practice of allowing healthy people to donate kidneys, given our findings that the risk of kidney failure resulting from doing so is extremely low," Dr. Dorry Segev, from Johns Hopkins University School of Medicine in Baltimore, Maryland, told Reuters Health by email.

Dr. Segev and colleagues compared the incidence of ESRD in 96,217 healthy U.S. adult kidney donors and a matched cohort of nondonors from the Third National Health and Nutrition Examination Survey (NHANES III).

Kidney donors had a somewhat higher estimated lifetime risk of developing ESRD (90 per 10,000) than similarly healthy nondonors (14 per 10,000), but still a much lower risk than the general population of unscreened nondonors (326 per 10,000), they reported in JAMA February 12.

"If you donate a kidney, you give up half of your reserve. You can live on this decreased reserve just fine, provided you don't have any other issues with your kidney. This means that if you weren't going to develop kidney disease in your life, then there's no extra risk to donating a kidney. But our study shows that if you were going to develop kidney disease at some point, you'll probably develop it faster if you start with the lower reserve that happens after you donate," Dr. Segev said.

"This makes biological sense, of course, because kidney disease is a progressive, chronic deterioration of kidney function, so if you start with less, you'll get failure faster," Dr. Segev explained. "However, this study reassures us that the risk of this happening in healthy, screened donors is extremely low."

The authors of an editorial published with the study say it would be easy to misinterpret the findings as suggesting that kidney donation is a risky procedure.

"In reality, the authors have shown that the absolute risk of ESRD among living donors is extremely low; this is their key finding and does not imply the need to alter existing clinical practice," write Dr. John S. Gill, of the University of British Columbia in Vancouver, and Dr. Marcello Tonelli, of the University of Alberta in Edmonton.

Dr. Segev and colleagues say it's "imperative that the transplant community, in due diligence to donors, understands the risk of donation to the fullest extent possible and communicates known risks to those considering donation."

They add, "These findings may help inform discussions with persons considering live kidney donation."

The study was supported by the Health Resources and Services Administration.

SOURCE: http://bit.ly/1m4aAn7

JAMA 2014;311:577-586.