Long-term clinical outcomes in living kidney donors

Results from a retrospective, comparative study, assessing long-term clinical outcomes in living kidney donors after nephrectomy (n = 87) vs matched controls (n = 100), were published in International Urology and Nephrology by Kontaş et al. The primary aim was to assess differences in outcomes including hypertension, diabetes, proteinuria, and glomerular filtration rate (GFR) reduction, and to identify contributing factors. 

Key data: Hypertension increased from 4.7% pre-donation to 36.0%  post-donation (p < 0.001). Multivariate analysis identified nephrectomy as an independent risk factor for hypertension (hazard ratio [HR] vs controls, 3.08; 95% confidence interval [CI], 1.49–6.37; p = 0.002), alongside age (HR, 1.04 per year; 95% CI, 1.00–1.07; p = 0.025) and body mass index (BMI; HR, 1.08 per kg/m²; 95% CI, 1.02–1.14; p = 0.006). Among donors, BMI ≥30 kg/m² was associated with a 2.55-fold increased risk of hypertension vs BMI <30 kg/m² (HR, 2.55; 95% CI, 1.19–5.47; p = 0.016). New-onset diabetes occurred in 9.9% of donors; each unit increase in post-donation BMI was associated with increased diabetes risk (HR, 1.09 per kg/m²; 95% CI, 1.03–1.15; p = 0.002). Donors had increased risk of >20% GFR decline vs controls (HR, 6.14; 95% CI, 2.50–15.06; p < 0.001). Proteinuria was unchanged pre- and post-donation in donors (p = 0.788). 

Key learning: These findings highlight the importance of comprehensive pre-donation assessments and individualized long-term follow-up, particularly for donors with older age and/or elevated BMI, to aid early identification and management of hypertension, diabetes, and renal function decline after nephrectomy.