Kidney Donors at Slightly Higher ESRD Risk

By age 80 years, the estimated lifetime risk of ESRD was 90 per 10,000 live donors.
By age 80 years, the estimated lifetime risk of ESRD was 90 per 10,000 live donors.

Individuals who donate a kidney have only a slightly increased lifetime risk of developing end-stage renal disease (ESRD) compared with healthy non-donors, but they are much less likely than the general population to develop ESRD. Both findings are probably due to the fact that potential organ donors are thoroughly tested to ensure they will be able to survive with just one kidney. population to develop ESRD.

“Compared with matched healthy non-donors, 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,” affirmed Dorry L. Segev, MD, PhD, and fellow investigators in the Journal of the American Medical Association.

Dr. Segev, a transplant surgeon at The Johns Hopkins Hospital in Baltimore, led what is believed to be the largest study of ESRD risk in living kidney donors, according to information from Johns Hopkins Medicine. The researchers analyzed medical records from all 96,217 living U.S. adults who donated a kidney from April 1994 to November 2011.

This information was compared with that from 20,024 participants in the Third National Health and Nutrition Examination Survey (NHANES III) who were linked to Centers for Medicare & Medicaid Services data to ascertain development of ESRD. ESRD was defined as the initiation of maintenance dialysis, placement on the transplant waiting list, or receipt of a living or deceased donor kidney transplant.

By age 80 years, the estimated lifetime risk of ESRD was 90 per 10,000 live donors, 14 per 10,000 healthy non-donors, and 326 per 10,000 unscreened non-donors (general population). During a median follow-up of 7.6 years (maximum 15.0 years), ESRD developed in 99 live donors in a mean of 8.6 years after donation. By comparison, during median follow-up of 15.0 years (maximum 15.0 years), ESRD developed in 36 matched healthy non-donors in 10.7 years.

The estimated risk of ESRD at 15 years after donation was 30.8 per 10,000 donors, and 3.9 per 10,000 matched healthy non-donors. Dr. Segev's group observed this difference in both black and white individuals. Blacks had the highest absolute risk of ESRD regardless of donor status.

As stated in the information from Johns Hopkins Medicine, all increased risk of ESRD in the white donors studied could be attributed to the donation itself, but one-third of ESRD cases in the black donors appeared to come from an inherent risk—something not identified during the donor screening process.

Dr. Segev and his team have launched a study to understand the increased risks for black kidney donors and to develop a more sensitive screening tool for this population.

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