Kidney Week

Abstract: FR-PO375

Kidney Failure and Mortality in Older Live Kidney Donors with Hypertension

Session Information

• Hypertension and CVD: Clinical, Outcomes, Trials
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

• Al Ammary, Fawaz, Johns Hopkins University, Baltimore, Maryland, United States

Fawaz Al Ammary,

• Luo, Xun, Johns Hopkins University, Baltimore, Maryland, United States

Xun Luo,

• Massie, Allan, Johns Hopkins University, Baltimore, Maryland, United States

Allan Massie,

• Henderson, Macey L., Johns Hopkins University, Baltimore, Maryland, United States

Macey L. Henderson,

• Crews, Deidra C., Johns Hopkins University, Baltimore, Maryland, United States

Deidra C. Crews,

• Garonzik wang, Jacqueline, Johns Hopkins University, Baltimore, Maryland, United States

Jacqueline Garonzik wang,

• Brennan, Daniel C., Johns Hopkins University, Baltimore, Maryland, United States

Daniel C. Brennan,

• Wiseman, Alexander C., University of Colorado at Denver and Health Sciences Center, Denver, Colorado, United States

Alexander C. Wiseman,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

Background

Hypertension in otherwise healthy, screened older live kidney donor candidates has been viewed as safe. However, hypertension guidelines have evolved and long-term outcomes for these donors have not been explored, which may bring this practice into question.

Methods

We used a US cohort of 24,533 older donors (≥50-year-old), including 2265 with predonation hypertension, to quantify the 15-year end-stage renal disease (ESRD) and mortality risk in donors with hypertension vs. those without hypertension. From 2004-2016, hypertension was defined as documented predonation use of antihypertensive therapy, regardless of systolic/diastolic blood pressure (SBP/DBP); from 1999-2003, when there was no documentation of antihypertensive therapy, hypertension was defined as predonation SBP≥140 or DBP≥90 mmHg.

Results

Older donors were 88.1% white, 5.6% Hispanic, and 6.3% black. Estimated 15-year ESRD risk was 77 per 10,000 (95%CI:38-155) for donors with hypertension (mean SBP=137.7 mmHg) vs. 21 per 10,000 (95%CI:12-37) for donors without hypertension (mean SBP=123.4 mmHg); (adjusted hazard ratio [HR] 3.04; 95%CI:1.28-7.22; P=.01). In the years when predonation use of antihypertensive therapy was available, risk of ESRD was 6.21-fold higher (95%CI:1.20-32.17; P=.03) for donors using antihypertensive therapy (mean SBP=131.9 mmHg) vs. those not using antihypertensive therapy (mean SBP=123.9 mmHg); this inference remained similar after further adjustment for SBP<125. There was no evidence of association between donor hypertension and 15-year mortality risk (HR 1.18; 95%CI:0.84-1.66; P=0.34).

Conclusion

Older kidney donor candidates with hypertension may be viewed as potentially high-risk for ESRD. These findings may help inform discussion with older candidates considering kidney donation; long-term monitoring is warranted.
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Funding

• NIDDK Support