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Self-Reported Incident Hypertension and Long-Term Kidney Function in Living Kidney Donors Compared with Healthy Nondonors.

  • Holscher, Courtenay M1
  • Haugen, Christine E1
  • Jackson, Kyle R1
  • Garonzik Wang, Jacqueline M1
  • Waldram, Madeleine M1
  • Bae, Sunjae1, 2
  • Locke, Jayme E3
  • Reed, Rhiannon D3
  • Lentine, Krista L4
  • Gupta, Gaurav5
  • Weir, Matthew R6
  • Friedewald, John J7
  • Verbesey, Jennifer8
  • Cooper, Matthew8
  • Segev, Dorry L9, 2
  • Massie, Allan B1, 2
  • 1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • 2 Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.
  • 3 Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama.
  • 4 Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri.
  • 5 Department of Medicine, Virginia Commonwealth University, Richmond, Virginia.
  • 6 Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
  • 7 Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and.
  • 8 MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC.
  • 9 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; [email protected]
Published Article
Clinical Journal of the American Society of Nephrology
American Society of Nephrology
Publication Date
Oct 07, 2019
DOI: 10.2215/CJN.04020419
PMID: 31537534


The risk of hypertension attributable to living kidney donation remains unknown as does the effect of developing postdonation hypertension on subsequent eGFR. We sought to understand the association between living kidney donation, hypertension, and long-term eGFR by comparing donors with a cohort of healthy nondonors. We compared 1295 living kidney donors with median 6 years of follow-up with a weighted cohort of 8233 healthy nondonors. We quantified the risk of self-reported hypertension using a parametric survival model. We examined the association of hypertension with yearly change in eGFR using multilevel linear regression and clustering by participant, with an interaction term for race. Kidney donation was independently associated with a 19% higher risk of hypertension (adjusted hazard ratio, 1.19; 95% confidence interval, 1.01 to 1.41; P=0.04); this association did not vary by race (interaction P=0.60). For white and black nondonors, there was a mean decline in eGFR (-0.4 and -0.3 ml/min per year, respectively) that steepened after incident hypertension (-0.8 and -0.9 ml/min per year, respectively; both P<0.001). For white and black kidney donors, there was a mean increase in eGFR after donation (+0.4 and +0.6 ml/min per year, respectively) that plateaued after incident hypertension (0 and -0.2 ml/min per year, respectively; P=0.07 and P=0.01, respectively, after hypertension). Kidney donors are at higher risk of hypertension than similar healthy nondonors, regardless of race. Donors who developed hypertension had a plateau in the usual postdonation increase of eGFR. Copyright © 2019 by the American Society of Nephrology.

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