Living kidney donation associated with some increased health risks

1. Living kidney donation was associated with higher diastolic blood pressure, lower estimated glomerular filtration rates, and increased relative risk of preeclampsia and end-stage renal disease (ESRD).

2. Data did not show that donors have a higher risk for type 2 diabetes, hypertension, cardiovascular disease, negative psychosocial health outcomes, reduced quality of life, or mortality.

Evidence Rating Level: 1 (Excellent)     

Study Rundown: Although the gold standard treatment for ESRD is living kidney donation, the long-term health risks of donating a kidney are uncertain.  This systematic review summarized the data for health risks in the mid- and long-term for adult living kidney donors.  The authors analyzed 52 studies including 118 426 donors and 117 656 nondonors.  Living kidney donation was linked to a higher relative risk (RR) for preeclampsia and ESRD.  However, the absolute risk for these events was low.  Donors also had higher diastolic blood pressure and lower estimated glomerular filtration rates.  In comparison to nondonors, donors did not have a higher risk for type 2 diabetes, hypertension, cardiovascular disease, negative psychosocial health outcomes, reduced quality of life, or mortality.  This data may help to better inform potential donors of the risks of kidney donation.  In addition, the evidence suggests that there should be long-term follow-up to monitor the health of living kidney donors.

A strength of this study is that it is the first quantitative assessment of a large variety of health outcomes for adult living kidney donors.  Limitations of this study include limited generalizability due to control group selection, limited studies with pregnancy-related results, and limited studies from countries of low- and middle-income.

Click to read the study in Annals of Internal Medicine

Click to read an accompanying editorial in Annals of Internal Medicine

Relevant Reading: The risk of living kidney donation

In-Depth [systematic review and meta-analysis]: Researchers used data from PubMed, Scopus, Embase, and PsycINFO spanning from April 1964 to July 2017.  Eligible studies had a minimum of 1 year of follow-up for health outcomes in adult living kidney donors compared to nondonors.  The authors evaluated 52 studies from 17 countries that included 118 426 donors and 117 656 nondonors.  Data did not show that donors have a higher risk for type 2 diabetes, hypertension, cardiovascular disease, negative psychosocial health outcomes, reduced quality of life, or mortality.  However, donors had higher diastolic blood pressure and lower estimated glomerular filtration rates.  In addition, donors had an increased risk of ESRD (RR 8.83) and preeclampsia (RR 2.12).  However, the absolute risk was low for both ESRD (incidence rate 0.5 events per 1000 person-years compared to 0.1 events in controls) and preeclampsia (incidence rate 5.9 events per 100 pregnancies compared to 3.1 events in controls).

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