Small Increase in ESRD Risk for Living Kidney Donors

Living kidney donors have a small but significant increase in the risk of ESRD compared with similarly healthy nondonors, reports the Journal of the American Medical Association.

The study included all 96,217 adult living kidney donors in the United States between 1994 and 2011, identified from the Organ Procurement and Transplantation Network. They were matched with 20,024 healthy nondonors who were free of contraindications to kidney donation, drawn from the Third National Health and Nutrition Examination Survey. Through linkage to data from the Centers for Medicare & Medicaid Services, the researchers compared the cumulative incidence and lifetime risk of ESRD for living donors versus nondonor control individuals.

There were 99 cases of ESRD in living kidney donors at a mean follow-up time of 8.6 years, compared with 36 cases in nondonors at 10.7 years. The estimated 15-year ESRD risk was 30.8 per 10,000 person-years in the living donors versus 3.9 per 10,000 person-years in the nondonor control individuals.

The increase in ESRD risk among living kidney donors was significant for both black donors, 74.7 versus 23.9 per 10,000 person-years; and white donors, 22.7 versus 0.0 per 10,000 person-years. The lifetime risk of ESRD was approximately 90 per 10,000 living donors. This was substantially higher than the 14 per 10,000 rate in healthy nondonor control individuals, but it was lower than the general population rate of 326 per 10,000 unscreened nondonors.

Previous studies have reported no increase in ESRD risk after living kidney donation. However, these studies have used control individuals from the general population, who are at higher inherent risk of ESRD than rigorously screened donors.

The new study shows a small but significant increase in long-term ESRD risk among living kidney donors compared with similarly healthy nondonor control individuals. The researchers note that the risk of ESRD after living donation is still much lower than in the unscreened general population. They conclude, “These findings may help inform discussions with persons considering live kidney donation” [Muzaale AD, et al. Risk of end-stage renal disease following live kidney donation. JAMA 2014; 311:579–586].