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. 2018 Oct;18(10):2534-2543.
doi: 10.1111/ajt.14713. Epub 2018 Apr 6.

Hypertension after kidney donation: Incidence, predictors, and correlates

Otto A Sanchez  1 , Laine K Ferrara  1 , Sarah Rein  1 , Danielle Berglund  2 , Arthur J Matas  3 , Hassan N Ibrahim  4
Affiliations

Hypertension after kidney donation: Incidence, predictors, and correlates

Otto A Sanchez et al. Am J Transplant. 2018 Oct.

Abstract

Incidence of postdonation hypertension, risk factors associated with its development, and impact of type of treatment received on renal outcomes were determined in 3700 kidney donors. Using Cox proportional hazard model, adjusted hazard ratios (HRs) for cardiovascular disease (CVD); estimated glomerular filtration rate (eGFR) <60, <45, <30 mL/min/1.73m2 ; end stage renal disease (ESRD); and death in hypertensive donors were determined. After a mean (standard deviation [SD]) of 16.6 (11.9) years of follow-up, 1126 (26.8%) donors developed hypertension and 894 with known antihypertensive medications. Hypertension developed in 4%, 10%, and 51% at 5, 10, and 40 years, respectively, and was associated with proteinuria, eGFR < 30, 45, and 60 mL/min/1.73m2 , CVD, and death. Blood pressure was <140/90 mm Hg at last follow-up in 75% of hypertensive donors. Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (compared to other antihypertensive agents) was associated with a lower risk for eGFR <45 mL/min/1.73m², HR 0.64 (95% confidence interval [CI] 0.45-0.9), P = .01, and also less ESRD; HR 0.03 (95% CI 0.001-0.20), P = .004. In this predominantly Caucasian cohort, hypertension is common after donation, well controlled in most donors, and factors associated with its development are similar to those in the general population.

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

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Figures

Figure 1
Figure 1. Study participants
Inclusion and exclusion criteria algorithm.
Figure 2
Figure 2. Observed and predicted progression of post donation blood pressure in those with and without post-donation hypertension
SBP = systolic blood pressure and DBP = diastolic blood pressure. Circles are observed values and lines are predicted values. The mean (SE) post donation SBP/DBP was greater in hypertensives donors 123.4 (0.4)/74.5 (0.3) mmHg than in non-hypertensives donors 120.7 (0.2)/73.6 (0.2) mmHg, p < 0.0001. The (mean (SE) SBP slope was greater for hypertensives donors than in non-hypertensive donors, p < 0.0001. The (mean (SE) slope for DBP was greater in non-hypertensives than in hypertensives, p < 0.0001.
Figure 3
Figure 3. Cumulative probability of post donation hypertension by quintiles at age of donation (A) and adjusted hazard ratios for incident hypertension (B)
Q = quintiles of age at time of donation. Q1 = 15.5 – 27.8, Q2 = 27.9 – 35.1, Q3 = 35.2 – 42.0, Q4 = 42.1 – 49.5 and Q5 = 49.5 – 74.9 years. For graph B, values are HRs (95% CI).
Figure 3
Figure 3. Cumulative probability of post donation hypertension by quintiles at age of donation (A) and adjusted hazard ratios for incident hypertension (B)
Q = quintiles of age at time of donation. Q1 = 15.5 – 27.8, Q2 = 27.9 – 35.1, Q3 = 35.2 – 42.0, Q4 = 42.1 – 49.5 and Q5 = 49.5 – 74.9 years. For graph B, values are HRs (95% CI).
Figure 4
Figure 4
Cumulative incidence of post donation hypertension by number of risk factors at time of donation.
Figure 5
Figure 5
Level of blood pressure control by hypertension status.
See this image and copyright information in PMC

References

    1. Brenner BM, Garcia DL, Anderson S. Glomeruli and blood pressure. Less of one, more the other? Am J Hypertens. 1988;1(4 Pt 1):335–347. - PubMed
    1. Kanzaki G, Tsuboi N, Haruhara K, Koike K, Ogura M, Shimizu A, et al. Factors associated with a vicious cycle involving a low nephron number, hypertension and chronic kidney disease. Hypertens Res. 2015;38(10):633–641. - PubMed
    1. Kasiske BL, Ma JZ, Louis TA, Swan SK. Long-term effects of reduced renal mass in humans. Kidney Int. 1995;48(3):814–819. - PubMed
    1. Boudville N, Prasad GV, Knoll G, Muirhead N, Thiessen-Philbrook H, Yang RC, et al. Meta-analysis: risk for hypertension in living kidney donors. Ann Intern Med. 2006;145(3):185–196. - PubMed
    1. Anjum S, Muzaale AD, Massie AB, Bae S, Luo X, Grams ME, et al. Patterns of End-Stage Renal Disease Caused by Diabetes, Hypertension, and Glomerulonephritis in Live Kidney Donors. Am J Transplant. 2016;16(12):3540–3547. - PMC - PubMed

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