Kidney Week

Abstract: TH-PO967

Nephrosclerosis beyond That Expected for Age Is Predictive of Early New-Onset Hypertension in Living Kidney Donors

Session Information

• Live Donor Outcomes and Kidney Transplantation in Pediatric and Ethnic/Racial Groups
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• Issa, Naim S., Mayo Clinic, Rochester, Minnesota, United States

Naim S. Issa,

• Vaughan, Lisa E., Mayo Clinic, Rochester, Minnesota, United States

Lisa E. Vaughan,

• Denic, Aleksandar, Mayo Clinic, Rochester, Minnesota, United States

Aleksandar Denic,

• Nagineni, Venkata vamsi, Mayo Clinic, Rochester, Minnesota, United States

Venkata vamsi Nagineni,

• Chakkera, Harini A., Mayo Clinic Arizona, Scottsdale, Arizona, United States

Harini A. Chakkera,

• Lieske, John C., Mayo Clinic, Rochester, Minnesota, United States

John C. Lieske,

• Lerman, Lilach O., Mayo Clinic, Rochester, Minnesota, United States

Lilach O. Lerman,

• Taler, Sandra J., Mayo Clinic, Rochester, Minnesota, United States

Sandra J. Taler,

• Stegall, Mark D., Mayo Clinic, Rochester, Minnesota, United States

Mark D. Stegall,

• Poggio, Emilio D., Cleveland Clinic, Cleveland, Ohio, United States

Emilio D. Poggio,

• Rule, Andrew D., Mayo Clinic, Rochester, Minnesota, United States

Andrew D. Rule,

Background

Nephrosclerosis on kidney biopsy of living donors is known to associate with older age and hypertension (HTN). Whether nephrosclerosis is also predictive of adverse kidney function changes early after donation is unclear.

Methods

We retrospectively studied living kidney donors who had an implantation renal biopsy as part of the Aging Kidney Anatomy study. Age-based thresholds (95^th percentile for 18-75 yo) were defined for glomerulosclerosis percentage (8-30%), cortical fibrosis (1-10%), number of fibrosis foci (1-6) and arteriosclerosis (60-76%). A Nephrosclerosis Index was defined assigning a value of 1 for each parameter that was abnormal. The Nephrosclerosis Index was assessed as a predictor of residual eGFR, eGFR<60 ml/min/1.73 m², elevated 24-hour albumin excretion, and new onset HTN (defined as SBP>140 or DBP>90 mm Hg or use of anti-hypertensive medications) after donation.

Results

There were 1409 donors available to define age-based thresholds of which 741 returned for a follow-up visit 2-24 months after donation (mean and median # months). The Nephrosclerosis Index was 0 in 65.3%, 1 in 26.2%, 2 in 6.3%, and 3 or higher in 2.2%. After adjusting for clinical predictors, baseline characteristics that associated with Nephrosclerosis Index were age (p<0.001) and HTN (p=0.003). After adjusting for age at donation, pre-donation HTN, and follow-up time, the Nephrosclerosis Index was not predictive of change in eGFR (p=0.89) at follow-up, a follow-up eGFR<60 ml/min/1.73 m² (p=0.56), or change in urine albumin (p=0.70). After excluding baseline HTN and adjusting for age and follow-up time, the Nephrosclerosis Index per level increase associated with new-onset HTN at follow-up (OR=1.9, p=0.021). A Nephrosclerosis Index of 2 or higher was also associated with new-onset HTN at follow-up (OR=4.2, p=0.017). An alternative analysis using single-thresholds rather than age-based thresholds for Nephrosclerosis Index found no association with new-onset HTN at follow-up.

Conclusion

Although uncommon, nephrosclerosis beyond that expected for age in a living kidney donor is associated with both prevalent HTN at donation and new-onset HTN at short-term follow-up.

Funding

• NIDDK Support