Hypertension and Kidney Function After Living Kidney Donation.

Autor:	Garg AX; Lawson Health Research Institute and London Health Sciences, London, Ontario, Canada.; ICES, Ontario, Canada.; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.; Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.; Department of Research Methods, Evidence and Uptake, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.; Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada., Arnold JB; Lawson Health Research Institute and London Health Sciences, London, Ontario, Canada., Cuerden MS; Lawson Health Research Institute and London Health Sciences, London, Ontario, Canada., Dipchand C; Department of Medicine (Nephrology), Queen Elizabeth II Health Sciences Centre and Dalhousie University Halifax, Nova Scotia, Canada., Feldman LS; Department of Surgery, McGill University, Montreal, Quebec, Canada., Gill JS; University of British Columbia, Vancouver, British Columbia, Canada., Karpinski M; University of Manitoba, Winnipeg, Manitoba, Canada., Klarenbach S; University of Alberta, Edmonton, Alberta, Canada., Knoll G; Department of Medicine (Nephrology), the Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada., Lok CE; University Health Network, Toronto, Ontario, Canada., Miller M; St Joseph's Healthcare, Hamilton, Ontario, Canada., Monroy-Cuadros M; University of Calgary, Calgary, Alberta, Canada., Nguan C; University of British Columbia, Vancouver, British Columbia, Canada., Prasad GVR; St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.; University of Toronto, Toronto, Ontario, Canada., Sontrop JM; Lawson Health Research Institute and London Health Sciences, London, Ontario, Canada.; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Storsley L; University of Manitoba, Winnipeg, Manitoba, Canada., Boudville N; Medical School, The University of Western Australia, Nedlands, Western Australia, Australia.; Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Jazyk:	angličtina
Zdroj:	JAMA [JAMA] 2024 Jul 23; Vol. 332 (4), pp. 287-299.
DOI:	10.1001/jama.2024.8523
Abstrakt:	Importance: Recent guidelines call for better evidence on health outcomes after living kidney donation. Objective: To determine the risk of hypertension in normotensive adults who donated a kidney compared with nondonors of similar baseline health. Their rates of estimated glomerular filtration rate (eGFR) decline and risk of albuminuria were also compared. Design, Setting, and Participants: Prospective cohort study of 924 standard-criteria living kidney donors enrolled before surgery and a concurrent sample of 396 nondonors. Recruitment occurred from 2004 to 2014 from 17 transplant centers (12 in Canada and 5 in Australia); follow-up occurred until November 2021. Donors and nondonors had the same annual schedule of follow-up assessments. Inverse probability of treatment weighting on a propensity score was used to balance donors and nondonors on baseline characteristics. Exposure: Living kidney donation. Main Outcomes and Measures: Hypertension (systolic blood pressure [SBP] ≥140 mm Hg, diastolic blood pressure [DBP] ≥90 mm Hg, or antihypertensive medication), annualized change in eGFR (starting 12 months after donation/simulated donation date in nondonors), and albuminuria (albumin to creatinine ratio ≥3 mg/mmol [≥30 mg/g]). Results: Among the 924 donors, 66% were female; they had a mean age of 47 years and a mean eGFR of 100 mL/min/1.73 m2. Donors were more likely than nondonors to have a family history of kidney failure (464/922 [50%] vs 89/394 [23%], respectively). After statistical weighting, the sample of nondonors increased to 928 and baseline characteristics were similar between the 2 groups. During a median follow-up of 7.3 years (IQR, 6.0-9.0), in weighted analysis, hypertension occurred in 161 of 924 donors (17%) and 158 of 928 nondonors (17%) (weighted hazard ratio, 1.11 [95% CI, 0.75-1.66]). The longitudinal change in mean blood pressure was similar in donors and nondonors. After the initial drop in donors' eGFR after nephrectomy (mean, 32 mL/min/1.73 m2), donors had a 1.4-mL/min/1.73 m2 (95% CI, 1.2-1.5) per year lesser decline in eGFR than nondonors. However, more donors than nondonors had an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up (438/924 [47%] vs 49/928 [5%]). Albuminuria occurred in 132 of 905 donors (15%) and 95 of 904 nondonors (11%) (weighted hazard ratio, 1.46 [95% CI, 0.97-2.21]); the weighted between-group difference in the albumin to creatinine ratio was 1.02 (95% CI, 0.88-1.19). Conclusions and Relevance: In this cohort study of living kidney donors and nondonors with the same follow-up schedule, the risks of hypertension and albuminuria were not significantly different. After the initial drop in eGFR from nephrectomy, donors had a slower mean rate of eGFR decline than nondonors but were more likely to have an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up. Trial Registration: ClinicalTrials.gov Identifier: NCT00936078.
Databáze:	MEDLINE
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