Donor Family History of ESKD and Long-term Outcomes Among African American Living Kidney Donors: A Retrospective Cohort Study

Abstract Rationale & Objective Live kidney donation is associated with a small increased risk of kidney disease and hypertension in African American donors. We investigated a possible association between donor family history of end stage kidney disease (ESKD) and their post-donation kidney function and development of hypertension. We tested if this association was modified by kidney donation. Study design Retrospective cohort Setting & Participants Former African American live kidney donors between 1993 and 2010. Healthy non-donors were selected from Coronary Artery Disease in Young Adults (CARDIA) study. Exposure Family history of ESKD in a first-degree relative Outcomes Kidney function and BP≥140/90 mmHg or use of anti-hypertensive medications at follow-up. Analytical Approach Donors were grouped based on family history of ESKD. Outcomes were first compared between donor groups and then between donors and healthy non-donors matched for demographics, follow-up time, and family history. A mixed-effect model was used to compare outcomes. Results Of the 179 donors, 139 (78%) had a first degree relative with ESKD. Pre-donation characteristics were similar between two groups. At a median follow-up of 11 years post-donation, there was no difference in post-donation eGFR (68±19 vs. 69±13 mL/min/1.73m2; p=0.71) and presence of albuminuria (p=0.16). There was a trend towards a higher incidence of hypertension (51% vs. 35%; p=0.08) among donors with a family history of ESKD than without. While there was no difference in annual change in eGFR (p=0.17) the risk of hypertension was higher in donors than non-donors (relative risk=2.44 [95% CI: 1.56-3.84]), but there was no interaction by family history (p=0.11). Limitations Retrospective small study. Lack of data across donor-recipient specific biological relationship Conclusions Family history of ESKD is not associated with post-donation kidney function among African American kidney donors. Live kidney donation is associated with an increased risk of hypertension among African Americans, independent of donor family history of ESKD.