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Kidney Donors and Kidney Failure – Once More, With Feeling

Recall Mjoen‘s latest research on living kidney donors who later develop end-stage renal disease? Here’s a recap: (emphasis mine)

 

Compared with controls, kidney donors had a significant 11.4 times increased risk of ESRD, 1.4 times increased risk of cardiovascular death, and 1.3 times increased risk of death from any cause, after adjusting for potential confounders.

The median time from donation was 18.7 years. ESRD was mainly caused by immunologic renal diseases.

 

In a recent issue of Kidney International, Boudville and Garg have a few remarks to make about Mjoen’s paper, specifically: (emphasis mine)

 

This paper demonstrates that living donors have poorer survival compared with matched non-donor controls, with the difference apparent only after 10 years of follow-up.

The paper also demonstrates an approximately 11-fold increase in the hazard ratio for ESRD in donors compared with matched non-donor controls.

 

And…

…an increased incidence rate of ESRD in donors compared with non-donor controls is now also corroborated in a recently presented abstract on almost 100,000 living kidney donors from the United States. In that study, the incidence rate of ESRD was eight-fold higher in donors.

 

What’s this now? Another study that says living kidney donors are at a  higher risk of kidney failure than non-donors? Written by folks in the US transplant industry??

Yes, indeed. Their conclusion (emphasis mine):

 

 Compared with matched healthy non-donors, kidney donors had an increased risk of ESRD over a median of 7.6 years

 

Less than 10 years. Considering the average US living kidney donor is 41 years old, that’s not only significant, but potentially catastrophic. What do Boudville and Garg suggest?

 

We will likely want a higher level of predonation kidney function (estimated glomerular filtration rate >90 ml/min/ 1.73m2) for younger individuals who are expected to live 50 or more years with one kidney (recognizing we do not have ideal evidence to inform what is the optimal acceptance threshold).

 

While this suggestion is, at least, something, a one-size-fits-all measure is not the best way to protect living kidney donors. After all, just a few years ago a Joint Societies* Consensus Group document on the medical evaluation of the living kidney donor recommended cut-offs based on age. Specifically, “one standard deviation below the mean”. Not surprisingly, this was written out of the final OPTN policy, but it’s still the most clinically sound method of preserving a living kidney donor’s post-kidney function.

It’s unfortunate OPTN and the transplant industry refuse to let facts get in the way of their opinions.

 

*the “joint societies” being all transplant related

 
Boudville, N., & Garg, A. (2014). End-stage renal disease in living kidney donors Kidney International, 86 (1), 20-22 DOI: 10.1038/ki.2013.560

Muzaale, A., Massie, A., Wang, M., Montgomery, R., McBride, M., Wainright, J., & Segev, D. (2014). Risk of End-Stage Renal Disease Following Live Kidney Donation JAMA, 311 (6) DOI: 10.1001/jama.2013.285141

Permanent link to this article: http://livingdonorsarepeopletoo.com/kidney-donors-and-kidney-failure-once-more-with-feeling/

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