Donors were
observed for a median follow-up time of 7.1 years after kidney donation to a
maximum of 18 years. Over
24 donors developed kidney failure and 252 died during the
study period.
Older donors
with hypertension had a 0.8 percent of risk failure in contrast to older donors
without hypertension who had only a 0.2 percent risk in the 15-year period.
The risk of kidney failure in older donors
with hypertension was 3.1 times higher when compared to those without
hypertension, but with similar clinical characteristics otherwise.
An even
stronger association of a 6.2-fold higher risk for kidney failure among donors
with hypertension was observed when only the donors from the 2004-2016 period
were included in the analysis. The restriction was a result of the unavailability
of documentation of antihypertensive therapy before this time.
However, there was no significant
association that was observed between donor hypertension and 15-year mortality.
Observations
"Fortunately, the number of kidney failure
events in this population is small. Albeit a rather small risk, practice
guidelines for live kidney donor evaluation need to be revisited," Dr. Al
Ammary said
. "While controlled
hypertension in otherwise eligible older individuals may not be viewed as an
absolute contraindication for kidney donation, these findings may inform
conversations between the provider and the older individuals with hypertension
when they consider donating a kidney," he added.
The study is
the largest to examine the long term risks that may be faced by older donors
with hypertension. The findings will be published in an upcoming issue of
Clinical Journal of the American Society of
Nephrology (CJASN). The research team plans to conduct further studies in
this area as the number of older individuals, who could be a very crucial
source of organs, for living donation is growing. This would be a great
advancement in the field of
organ transplantation.
Using the Findings
Dr. Kenneth
Newell (Emory University School of Medicine) and Dr. Richard Formica, Jr. (Yale
University School of Medicine) have made some observations on how the findings
should be used, in an accompanying editorial.
The findings,
"Should not be used to 'allow or 'exclude' individuals from proceeding
with living kidney donation but rather should be incorporated into a
comprehensive educational program to better inform donors about the long-term
consequences of their decision to be a living kidney donor. In addition, these findings identify a cohort of
medically complex living kidney donors who should be offered the opportunity to
enroll in specialized programs to provide lifetime surveillance for and
treatment of conditions associated with an increased risk of end-stage kidney disease."
References : - Risk of ESKD in Older Live Kidney Donors with Hypertension - (https://cjasn.asnjournals.org/content/early/2019/06/24/CJN.14031118)
Source: Medindia
