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Clinical Research
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Quantifying Postdonation Risk of ESRD in Living Kidney Donors

Allan B. Massie, Abimereki D. Muzaale, Xun Luo, Eric K.H. Chow, Jayme E. Locke, Anh Q. Nguyen, Macey L. Henderson, Jon J. Snyder and Dorry L. Segev
JASN September 2017, 28 (9) 2749-2755; DOI: https://doi.org/10.1681/ASN.2016101084
Allan B. Massie
*Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
†Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland;
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Abimereki D. Muzaale
*Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
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Xun Luo
*Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
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Eric K.H. Chow
*Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
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Jayme E. Locke
‡Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; and
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Anh Q. Nguyen
*Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
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Macey L. Henderson
*Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
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Jon J. Snyder
§Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
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Dorry L. Segev
*Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
†Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland;
§Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
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    Figure 1.

    Cumulative incidence of ESRD was lowest among living donors with BMI <25 and highest among donors with BMI>30 and it was higher among donors who were first-degree biologically related to their recipient. Incidence of ESRD is stratified separately by BMI category (A) and relatedness to recipient (B).

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    Figure 2.

    Among nonblack donors, older age groups had higher cumulative incidence of ESRD, whereas among black donors, older age groups had lower risk of ESRD.

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    Figure 3.

    Among all donors in the study, the full range of predicted risk of ESRD was wide, with median (IQR) range of 1 (1–2) cases per 10,000 donors at 5 years postdonation; 6 (4–11) per 10,000 at 10 years postdonation; 16 (10–29) per 10,000 at 15 years postdonation; and 34 (20–59) per 10,000 at 20 years postdonation. Predicted risk of postdonation ESRD for each donor was calculated on the basis of donor characteristics. The median donor had 34 per 10,000 predicted risk of ESRD at 20 years postdonation. Half of all donors have predicted risk between the two dashed lines, but 1% of donors had predicted 20-year ESRD risk exceeding 256 per 10,000.

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    Figure 4.

    Close calibration of observed and predicted cumulative incidence of ESRD. The calibration is stratified by sex in (A) and by race in (B). The plots show good agreement between observed and predicted values.

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    Table 1.

    Characteristics of living donors in the United States, 1987–2014

    CharacteristicNo ESRDESRD
    N133,493331
    Median (IQR) yr of donation2004 (1999–2010)1995 (1991–2000)
    Median (IQR) age at donation40 (31–48)38 (30–48)
    Median (IQR) BMI at donation, kg/m2a26.6 (23.7–29.7)28.9 (24.4–31.4)
    Men, %40.760.4
    Black, %12.534.4
    First-degree biologically related to recipient, %59.485.6
     Sibling of recipient29.946.8
     Child of recipient16.018.2
     Parent of recipient13.520.9
    • ↵a BMI at donation and relationship to recipient were missing for 31.0% of donors and 0.7% of donors, respectively. Missingness of BMI was primarily due to incomplete reporting before 1999. In regression analyses, multiple imputation was used to account for missing data.

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    Table 2.

    Risk factors for ESRD in living kidney donors

    CharacteristicaHRaP Value
    Men (at age 40) 1.88 (95% CI, 1.50 to 2.35)<0.001
    black race (at age 40)2.96 (95% CI, 2.25 to 3.89)<0.001
    Age per 10 yr: nonblack1.40 (95% CI, 1.23 to 1.59)<0.001
    Age per 10 yr: black0.88 (95% CI, 0.72 to 1.09)0.3
    BMI per 5 kg/m21.61 (95% CI, 1.29 to 2.00)<0.001
    First-degree biologically related to recipient1.70 (95% CI, 1.24 to 2.34)<0.01
    • ↵a Male sex and greater BMI were associated with higher risk of ESRD (both P<0.001). Older age was associated with higher risk of ESRD in nonblack male donors (P<0.001), but the association between age and risk was not statistically significant in black donors (P=0.1). Donors who were closely related to their recipient had higher risk of ESRD (P<0.01).

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Journal of the American Society of Nephrology: 28 (9)
Journal of the American Society of Nephrology
Vol. 28, Issue 9
September 2017
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Quantifying Postdonation Risk of ESRD in Living Kidney Donors
Allan B. Massie, Abimereki D. Muzaale, Xun Luo, Eric K.H. Chow, Jayme E. Locke, Anh Q. Nguyen, Macey L. Henderson, Jon J. Snyder, Dorry L. Segev
JASN Sep 2017, 28 (9) 2749-2755; DOI: 10.1681/ASN.2016101084

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Quantifying Postdonation Risk of ESRD in Living Kidney Donors
Allan B. Massie, Abimereki D. Muzaale, Xun Luo, Eric K.H. Chow, Jayme E. Locke, Anh Q. Nguyen, Macey L. Henderson, Jon J. Snyder, Dorry L. Segev
JASN Sep 2017, 28 (9) 2749-2755; DOI: 10.1681/ASN.2016101084
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