Risk of end-stage renal disease following live kidney donation.

[Clark]

http://www.ncbi.nlm.nih.gov/pubmed/24519297

JAMA. 2014 Feb 12;311(6):579-86. doi: 10.1001/jama.2013.285141.
Risk of end-stage renal disease following live kidney donation.
Muzaale AD1, Massie AB1, Wang MC2, Montgomery RA1, McBride MA3, Wainright JL3, Segev DL4.
Author information
Abstract
IMPORTANCE:
Risk of end-stage renal disease (ESRD) in kidney donors has been compared with risk faced by the general population, but the general population represents an unscreened, high-risk comparator. A comparison to similarly screened healthy nondonors would more properly estimate the sequelae of kidney donation.
OBJECTIVES:
To compare the risk of ESRD in kidney donors with that of a healthy cohort of nondonors who are at equally low risk of renal disease and free of contraindications to live donation and to stratify these comparisons by patient demographics.
DESIGN, SETTINGS, AND PARTICIPANTS:
A cohort of 96,217 kidney donors in the United States between April 1994 and November 2011 and a cohort of 20,024 participants of the Third National Health and Nutrition Examination Survey (NHANES III) were linked to Centers for Medicare & Medicaid Services data to ascertain development of ESRD, which was defined as the initiation of maintenance dialysis, placement on the waiting list, or receipt of a living or deceased donor kidney transplant, whichever was identified first. Maximum follow-up was 15.0 years; median follow-up was 7.6 years (interquartile range [IQR], 3.9-11.5 years) for kidney donors and 15.0 years (IQR, 13.7-15.0 years) for matched healthy nondonors.
MAIN OUTCOMES AND MEASURES:
Cumulative incidence and lifetime risk of ESRD.
RESULTS:
Among live donors, with median follow-up of 7.6 years (maximum, 15.0), ESRD developed in 99 individuals in a mean (SD) of 8.6 (3.6) years after donation. Among matched healthy nondonors, with median follow-up of 15.0 years (maximum, 15.0), ESRD developed in 36 nondonors in 10.7 (3.2) years, drawn from 17 ESRD events in the unmatched healthy nondonor pool of 9364. Estimated risk of ESRD at 15 years after donation was 30.8 per 10,000 (95% CI, 24.3-38.5) in kidney donors and 3.9 per 10,000 (95% CI, 0.8-8.9) in their matched healthy nondonor counterparts (P < .001). This difference was observed in both black and white individuals, with an estimated risk of 74.7 per 10,000 black donors (95% CI, 47.8-105. vs 23.9 per 10,000 black nondonors (95% CI, 1.6-62.4; P < .001) and an estimated risk of 22.7 per 10,000 white donors (95% CI, 15.6-30.1) vs 0.0 white nondonors (P < .001). Estimated lifetime risk of ESRD was 90 per 10,000 donors, 326 per 10,000 unscreened nondonors (general population), and 14 per 10,000 healthy nondonors.
CONCLUSIONS AND RELEVANCE:
Compared with matched healthy nondonors, kidney donors had an increased risk of ESRD over a median of 7.6 years; however, the magnitude of the absolute risk increase was small. These findings may help inform discussions with persons considering live kidney donation.
Comment in
Understanding rare adverse outcomes following living kidney donation. [JAMA. 2014]
PMID: 24519297 [PubMed - in process]

[Clark]

http://jama.jamanetwork.com/article.aspx?articleid=1829665

Understanding Rare Adverse Outcomes Following Living Kidney Donation
John S. Gill, MD1,2,3; Marcello Tonelli, MD4,5,6

• Author Affiliations

JAMA. 2014;311(6):577-579. doi:10.1001/jama.2013.285142.

A new era in the treatment of patients with end-stage renal disease (ESRD) was heralded by the first successful kidney transplant in 1954—a living donor transplant between identical twins. A 23-year-old man donated his kidney to his brother and survived until the age of 81 years with a solitary kidney.1 Today, kidney transplantation is the treatment of choice for patients with ESRD, and the shortage of transplantable organs is the major issue limiting the field.2 Both living and deceased organ donations are recognized as critical practices to meet the increasing demand for kidney transplants. The availability of a living donor allows for timely transplants and is associated with superior outcomes compared with dialysis or transplants from deceased donors. In developing countries, where chronic dialysis is too expensive for most families (and the infrastructure to support deceased donation is unavailable), living donor transplant is often the most feasible treatment option. In 2011, living donors provided 42.5% of all transplanted kidneys, with more than 31 000 procedures performed in more than 100 countries.

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[Fr Pat]

Dear Clark,
     I`m unclear about which study you are referring to. The first study posted above seems to be measuring when "end stage renal disease" is first diagnosed and treatment begins, not when death occurs. Am I misunderstanding something?
     Fr. Pat

[Clark]

You're right, Fr. Pat, my mistake, I was caught up in my concern about a different study by most of the same authors.