Older living kidney donors with hypertension may be at increased risk of developing kidney failure themselves, according to new national research published online ahead of print in the Clinical Journal of the American Society of Nephrology.

Fawaz Al Ammary, MD, PhD, of Johns Hopkins University in Baltimore, and colleagues studied 24,533 kidney donors aged 50 years and older (82% white) from the US Scientific Registry of Transplant Recipients during 1999 to 2016. Of these, 2265 had systolic or diastolic blood pressure at or above 140 or 90 mm Hg, respectively, or used antihypertensive therapy before donation. Mean predonation systolic BP was 138 mm Hg for donors with hypertension compared with 123 mm Hg for donors without hypertension.

Over a median 7.1 years, 24 donors progressed to end-stage renal disease and 252 died. Hypertension at the time of donation was associated with greater risk for kidney failure within 15 years—0.8% with hypertension and 0.2% without hypertension—but not death. Kidney failure risk was 3-fold higher for these hypertensive older donors and 6-fold higher in the subgroup from 2004 to 2016, who received documented antihypertensive therapy (i.e., dietary restriction, diuretics, nondiuretics, or combination therapies).

Older adults are a growing population of potential living donors, the investigators noted. “These findings may help inform discussions with older candidates considering kidney donation. Long-term monitoring of systolic BP and kidney profile is suggested,” Dr Al Ammary and colleagues stated.

In an accompanying editorial, Kenneth Newell, MD, PhD, of Emory University in Atlanta, and Richard Formica, Jr., MD, of Yale University in New Haven, Connecticut, reinforced the advice: “The findings of this study should not be used to ‘allow’ or ‘exclude’ individuals from proceeding with living kidney donation but rather should be incorporated into a comprehensive educational program to better inform donors about the long-term consequences of their decision to be a living kidney donor.” The editorialists called for specialized programs to provide lifetime surveillance and treatment for medically complex living donors.

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References

Al Ammary F, Luo X, Muzaale A, et al. Risk of End-stage kidney disease in older live kidney donors with hypertension. Clin J Am Soc Nephrol. doi:10.2215/CJN.14031118. Accessed June 25, 2019.

ESKD risk in living kidney donors ‘like me.’ Clin J Am Soc Nephrol. Accessed June 25, 2019.

Does hypertension pose a health risk to older adults who wish to donate a kidney? [news release] Washington, DC. American Society of Nephrology; June 20, 2019.