Patterns of End-Stage Renal Disease Caused by Diabetes, Hypertension, and Glomerulonephritis in Live Kidney Donors

Abstract

Inferences about late risk of end-stage renal disease (ESRD) in live kidney donors have been extrapolated from studies averaging <10 years of follow-up. Because early (<10 years) and late (≥10 years) postdonation ESRD may differ by causal mechanism, it is possible that extrapolations are misleading. To better understand postdonation ESRD, we studied patterns of common etiologies including diabetes, hypertension and glomerulonephritis (GN; as reported by providers) using donor registry data linked to ESRD registry data. Overall, 125 427 donors were observed for a median of 11.0 years (interquartile range 5.3-15.7 years; maximum 25 years). The cumulative incidence of ESRD increased from 10 events per 10 000 at 10 years after donation to 85 events per 10 000 at 25 years after donation (late vs. early ESRD, adjusted for age, race and sex: incidence rate ratio [IRR] _1.3 1.7_2.3 [subscripts are 95% confidence intervals]). Early postdonation ESRD was predominantly reported as GN-ESRD; however, late postdonation ESRD was more frequently reported as diabetic ESRD and hypertensive ESRD (IRR _2.3 7.7_25.2 and _1.4 2.6_4.6 , respectively). These time-dependent patterns were not seen with GN-ESRD (IRR _0.4 0.7_1.2 ). Because ESRD in live kidney donors has traditionally been reported in studies averaging <10 years of follow-up, our findings suggest caution in extrapolating such results over much longer intervals.

Keywords: clinical research/practice; donors and donation: donor follow-up; donors and donation: living; kidney transplantation/nephrology.

Figure 1. Hazard rate and cumulative incidence of cause-specific end stage renal disease (ESRD) in live kidney donors, United States, October 1, 1987 – July 31, 2014

Kaplan-Meier (green, solid line) and generalized gamma model (GG) (orange, dashed line; 95% CI solid) illustrate, for diabetes: a low unadjusted hazard rate of ESRD <10 years postdonation (_0.10.2_0.3 cases per 10,000 donors per year at 10 years) and a substantial increase in unadjusted hazard rate of ESRD 10–25 years postdonation (_1.02.5_3.8 cases per 10,000 donors per year at 25 years); hypertension: a low unadjusted hazard rate of ESRD 0–10 years (_0.50.6_0.8 cases per 10,000 donors per year) and a substantial increase in unadjusted hazard rate of ESRD 10–25 years (_1.72.9_4.1 cases per 10,000 donors per year); and for glomerulonephritis (GN): a relatively constant unadjusted hazard rate of ESRD 0–25 years postdonation (_0.50.61_0.8 per 10,000 donors per year at 10 years vs. _0.30.67_1.3 cases per 10,000 donors per year at 25 years. As per GG, the cumulative incidence of cause-specific ESRD at 25 years was _9.316.6_22.7, _19.026.8_33.7, and _9,113.4_17.7 per 10,000 donors for diabetes, hypertension, and GN (very closely approximating the Kaplan-Meier estimates)