71.07 Early Hypertension, Diabetes, and Proteinuria After Kidney Donation: A National Cohort Analysis

C. Holscher¹, S. Bae¹, M. Henderson¹, S. DiBrito¹, C. Haugen¹, A. Muzaale¹, A. Massie¹, J. Garonzik Wang¹, D. Segev^{1  1}Johns Hopkins University,Baltimore, MD, USA

Introduction:  Living kidney donors (LKDs) are at greater risk of end stage renal disease (ESRD) than the general population. While late post-donation ESRD is more likely due to hypertension (HTN) or diabetes (DM), early post-donation ESRD is often secondary to glomerulonephritis and is associated with proteinuria. Better understanding of the prevalence of and risk factors for early post-donation proteinuria, HTN, and DM will improve LKD follow-up care.

Methods:  Using SRTR data, we identified 41260 LKDs who underwent donor nephrectomy from 2008-2014 with follow-up data included through 2017. Given the high loss to follow-up (59% missing proteinuria, 33% missing HTN, and 31% missing DM), sensitivity analyses were done using inverse probability weighting (IPW) and multiple imputation by chained equations (MICE). Multiple logistic regression models were used to compare risk factors for proteinuria, HTN, and DM.

Results: Among LKDs, _1.55%1.70%_1.86% had HTN, _0.06%0.09%_0.13% had DM, and _5.11%5.47%_5.84% had proteinuria at two years post-donation. Sensitivity analyses revealed similar estimates of HTN and DM, but slightly higher estimates of proteinuria [_6.09%6.44%_6.84% (IPW) and _6.35%6.72%_7.23% (MICE)]. HTN was more likely in older (for each 10 years, aOR: _1.341.49_1.66), more obese (for each 5 BMI units, aOR: _1.171.34_1.53), and hypertensive (for each 10 mmHg, aOR: _1.351.45_1.56) LKDs. HTN was less likely in LKDs who had donated more recently (by year, aOR: _0.900.94_1.00), were female (aOR: _0.630.78_0.97), Hispanic/Latino (

Reference: white, aOR: _0.430.64_0.94), and not related to the recipient (aOR: _0.580.73_0.93). DM was more likely in LKDs who were Hispanic/Latino (aOR: _1.393.85_10.64) and had higher BMIs (aOR: _1.131.93_3.28). Proteinuria was more likely in LKDs who had higher BMIs (aOR: _1.121.23_1.36) and in African American LKDs (aOR: _1.481.85_2.32) and Hispanic/Latino LKDs (aOR: _1.211.51_1.88) relative to white LKDs. Proteinuria was less likely in LKDs who were older (aOR: _0.770.83_0.90), female (aOR: _0.640.76_0.89), and were not related to their recipient (aOR: _0.700.83_0.99, Table). 

Conclusion: The low early post-nephrectomy prevalence of HTN, DM, and proteinuria in LKDs is reassuring and suggests risk of ESRD is limited to a small proportion of LKDs. Improved understanding of which LKDs are at risk for these conditions might improve pre-donation risk stratification and counseling as well as post-donation prevention of ESRD.