Differences in “Early” and “Late” ESRD in Live Kidney Donors

Patterns of end stage renal disease (ESRD) among live kidney donors may differ for those with ESRD developing earlier versus later in the postdonation period, suggests a study in the American Journal of Transplantation.

The researchers analyzed more than 125,000 US live kidney donors who underwent donor nephrectomy between 1987 and 2014, drawn from the Scientific Registry of Transplant Recipients. Median follow-up was 11 years; 59% of donors underwent nephrectomy between 1987 and 2005. Cause-specific cumulative incidence of ESRD due to diabetes, hypertension, and glomerulonephritis was analyzed for each successive postdonation year.

Over approximately 1.3 million person-years of follow-up, 257 donors developed ESRD. In 61% of patients, the cause was diabetes (33 cases), hypertension (70 cases), or glomerulonephritis (55 cases). Cumulative incidence of ESRD was 10 events per 10,000 donors per year at 10 years after donation versus 85 per 10,000 at 25 years. After adjustment for age, sex, and race, the incidence rate ratio for late versus early ESRD was 1.77.

Glomerulonephritis predominated as the cause of early postdonation ESRD, but diabetes and hypertension were more frequent in the late postdonation period: IRR 7.7 and 2.6, respectively. There was no significant time-dependent pattern for glomerulonephritis-related ESRD.

Studies of ESRD in live kidney donors have typically averaged less than 10 years’ follow-up. The new findings highlight the need for caution in extrapolating these findings over longer periods. The increases in ESRD due to diabetes and hypertension underscore the importance of close monitoring of blood glucose and renal function, continuing for decades after nephrectomy [Anjum S, et al. Patterns of end-stage renal disease caused by diabetes, hypertension, and glomerulonephritis in live kidney donors. Am J Transpl 2016; 16:3540–3547].