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Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors

Journal Paper/Review - Mar 22, 2016

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Citation
Thiel G, Nolte C, Tsinalis D, Steiger J, Bachmann L. Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors. BMJ Open 2016; 6:e010869.
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Type
Journal Paper/Review (English)
Journal
BMJ Open 2016; 6
Publication Date
Mar 22, 2016
Issn Print
Issn Electronic
2044-6055
Pages
e010869
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Brief description/objective

OBJECTIVES
To assess the role of nephrectomy as a risk factor for the development of hypertension and microalbuminuria.

DESIGN
Prospective, long-term follow-up study.

SETTING
Swiss Organ Living-Donor Health Registry.

PARTICIPANTS
All living kidney donors in Switzerland between 1993 and 2009.

INTERVENTIONS
Data on health status and renal function before 1 year and biennially after donation were collected.

PRIMARY AND SECONDARY OUTCOME MEASURES
Comparison of 1-year and 5-year occurrences of hypertension among normotensive donors with 1-year and 5-year estimates from the Framingham hypertension risk score. Multivariate random intercept models were used to investigate changes of albumin excretion after donation, correcting for repeated measurements and cofactors such as age, male gender and body mass index.

RESULTS
A total of 1214 donors contributed 3918 data entries with a completed biennial follow-up rate of 74% during a 10-year period. Mean (SD) follow-up of donors was 31.6 months (34.4). Median age at donation was 50.5 years (IQR 42.2-58.8); 806 donors (66.4%) were women. Donation increased the risk of hypertension after 1 year by 3.64 (95% CI 3.52 to 3.76; p<0.001). Those participants remaining normotensive 1 year after donation return to a risk similar to that of the healthy Framingham population. Microalbuminuria before donation was dependent on donor age but not on the presence of hypertension. After nephrectomy, hypertension became the main driver for changes in albumin excretion (OR 1.19; 95% CI 0.13 to 2.25; p=0.03) and donor age had no effect.

CONCLUSIONS
Nephrectomy propagates hypertension and increases susceptibility for the development of hypertension-induced microalbuminuria.