An analysis of nearly 100,000 kidney donors finds that there is a small increased lifetime risk of developing end-stage renal disease following donation compared with healthy nondonors, although the risk is still much lower than that in the general population, according to a study in the February 12 issue of JAMA.
Every year in the United States, approximately 6,000 healthy adults accept the risks of kidney donation to help family members, friends, or even strangers. "It is imperative that the transplant community, in due diligence to donors, understands the risk of donation to the fullest extent possible and communicates known risks to those considering donation," according to background information in the article.
Abimereki D. Muzaale, M.D., M.P.H., of the Johns Hopkins University School of Medicine, Baltimore, and colleagues compared the incidence of end-stage renal disease (ESRD) in donors and healthy nondonors to better understand the risk of ESRD. The study included 96,217 kidney donors (donation between 1994-2011) in the United States and a group of 20,024 participants of 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 (defined as the initiation of maintenance dialysis, placement on the transplant waiting list, or receipt of a living or deceased donor kidney transplant).
The estimated cumulative incidence of ESRD at 15 years after donation was 30.8 per 10,000 in donors and 3.9 per 10,000 in healthy nondonors. This higher incidence among donors was observed in both black and white donors; absolute risk of ESRD was highest among blacks, regardless of their donor status. By age 80 years, the estimated lifetime risk of ESRD was 90 per 10,000 in donors vs 14 per 10,000 in healthy nondonors. Live donors had much lower estimated lifetime risk of ESRD than did the general population (unscreened nondonors; 326 per 10,000).
The authors write that their findings reaffirm the prevailing belief that lifetime risk of ESRD in live donors is no higher than in the general demographics-matched U.S. population.
"Compared with a matched cohort of healthy nondonors, kidney donors had an increased risk of ESRD; however, the magnitude of the absolute risk increase was small. These findings may help inform discussions with persons considering live kidney donation."
(doi:10.1001/jama.2013.285141; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This study was supported by a grant from the Health Resources and Services Administration. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
Editorial: Understanding Rare Adverse Outcomes Following Living Kidney Donation
In an accompanying editorial, John S. Gill, M.D., of the University of British Columbia, Vancouver, and Marcello Tonelli, M.D., of the University of Alberta, Edmonton, discuss the potential limitations of this study and the very low absolute risk of ESRD following live kidney donation.
"It would be easy to misinterpret the findings of Muzaale et al as suggesting that kidney donation is a risky procedure. In reality, the authors have shown that the absolute risk of ESRD among living donors is extremely low; this is their key finding and does not imply the need to alter existing clinical practice."
"… it would be prudent for clinicians to emphasize the absolute risk of ESRD in discussions with prospective living donors, ideally using a decision aid that will facilitate the process of obtaining informed consent."
(doi:10.1001/jama.2013.285142; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
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JAMA