Brief Report: Patterns of End Stage Renal Disease Caused by Diabetes, Hypertension, and Glomerulonephritis in Live Kidney Donors

Abstract

Inferences about late risk of end-stage renal disease (ESRD) in live kidney donors have been extrapolated from studies averaging <10 years of follow-up. Since early postdonation ESRD (<10 years postdonation) and late postdonation ESRD (10+ years postdonation) may differ by causal mechanism, it is possible that extrapolations are misleading. To better understand postdonation ESRD, we studied patterns of common etiologies including diabetes, hypertension, and glomerulonephritis (GN)(as reported by providers) using donor-registry data linked to ESRD-registry data. Overall, 125,427 donors were observed for a median of 11.0 years (interquartile range 5.3–15.7; maximum 25). The cumulative incidence of ESRD increased from 10 events per 10,000 at 10 years postdonation to 85 events per 10,000 at 25 years postdonation (incidence rate ratio [IRR] for late vs. early ESRD [adjusted for age, race, and sex]: _1.31.7 _2.3 [subscripts are 95% confidence intervals]). Early postdonation ESRD was predominantly reported as GN-ESRD; however, late postdonation ESRD was more frequently reported as diabetic-ESRD and hypertensive-ESRD (IRR _2.37.7 _25.2 and _1.42.6 _4.6). These time-dependent patterns were not seen with GN-ESRD (IRR _0.40.7 _1.2). Since ESRD in live kidney donors has traditionally been reported in studies averaging <10 years of follow-up, our findings suggest caution in extrapolating such results over much longer intervals.