Adherence to Medical Appointments Among Living Kidney Donors After Donation Under a Monitored Approach and Long-term Clinical Outcomes: A Brazilian Single-center Cohort Study.

Abstract Background There is little information about living donor long-term follow-up among Brazilian living donors. The aim of this study was to evaluate the main outcomes among living donors and to measure their adherence to regular medical appointments. Methods This is a Brazilian single-center cohort study that included 397 living donors with 87.1 months of follow-up and measured adherence to clinical appointments. Before 2010, the appointments were scheduled only spontaneously; after that an approach was structured to check the returns of donors, who were monitored actively. We also evaluated long-term outcomes such as survival and chronic kidney disease development and, secondarily, the incidences of hypertension, diabetes mellitus (DM), and dyslipidemia after donation. Results The donors' adherence to annual clinical appointments was 75.8% (54.7% of them presenting annual regularity). Before 2010 the adherence was lower than 40%; 10-year cumulative incidences of hypertension, DM, and dyslipidemia were 20.4%, 5.7%, and 23.5%, respectively. The crude mortality was 1% and 10-year donor survival was 98.5%. The incidence of chronic kidney disease 5 years after donation was 19%, with 16.4% of patients staged in 3a and 2.6% in 3b. Conclusion A structured approach to check donor returns to long-term clinical appointments has doubled the adherence to visits returns (compared to historical data). We identified lower incidence of arterial hypertension and DM among donors as compared with the incidence of arterial hypertension and DM in the Brazilian general population, but the 5-year chronic kidney disease incidence was considered high, taking into consideration data that have been published in the last years.