TY - JOUR
T1 - Risk of ESKD in older live kidney donors with hypertension
AU - Al Ammary, Fawaz
AU - Luo, Xun
AU - Muzaale, Abimereki D.
AU - Massie, Allan B.
AU - Crews, Deidra C.
AU - Waldram, Madeleine M.
AU - Qadi, Mohamud A.
AU - Garonzik-Wang, Jacqueline
AU - Henderson, Macey L.
AU - Brennan, Daniel C.
AU - Wiseman, Alexander C.
AU - Lindrooth, Richard C.
AU - Snyder, Jon J.
AU - Coresh, Josef
AU - Segev, Dorry L.
N1 - Funding Information:
Dr. Al Ammary had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Dr. Al Ammary, Dr. Luo, Dr. Muzaale, and Dr. Massie. Acquisition of data: Dr. Al Ammary, Dr. Luo, Dr. Massie, Dr. Snyder, and Dr. Segev. Analysis and interpretation of data: Dr. Al Ammary, Dr. Muzaale, Dr. Luo, Dr. Massie, Dr. Coresh, Dr. Brennan, and Dr. Segev. Drafting of the manuscript: Dr. Al Ammary, Dr. Muzaale, and Dr. Segev. Critical revision of the manuscript for important intellectual content: Dr. Al Ammary, Dr. Muzaale, Dr. Luo, Dr. Massie, Dr. Crews, Dr. Waldram, Dr. Qadi, Dr. Garonzik-Wang, Dr. Henderson, Dr. Brennan, Dr. Wiseman, Dr. Lindrooth, Dr. Coresh, and Dr. Segev. Statistical analysis: Dr. Al Ammary, Dr. Luo, Dr. Muzaale, Dr. Massie, andDr. Segev. Obtainedfunding: Dr. Segev. Administrative, technical, and material support: Dr. Henderson, Dr. Garonzik-Wang, and Dr. Massie. Study supervision: Dr. Segev. Scientific Registry of Transplant Recipients staff performed all Social Security number linkages to Social Security Death Master File and Centers for Medicare and Medicaid Services data to ensure confidentiality of Social Security number data provided to the Organ Procurement and Transplantation Network. This study was supported by the following grants from the National Institute of Diabetes and Digestive and Kidney Diseases: K24DK101828 (awarded to Dr. Segev), K01DK101677 (awarded to Dr. Massie), K01DK114388-01 (awarded to Dr. Henderson), and 1K23DK115908-01 (awarded to Dr. Garonzik-Wang). Dr. Snyder is supported under the Scientific Registry of Transplant Recipients contract HHSH250201500009C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). The analyses described herein are the responsibility of the authors alone and do not necessarily reflect the views or policies of the US Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the US Government. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the Scientific Registry of Transplant Recipients or the US Government. Disclosures.
Funding Information:
This study was supported by the following grants from the National Institute of Diabetes and Digestive and Kidney Diseases: K24DK101828 (awarded to Dr. Segev), K01DK101677 (awarded to Dr. Massie), K01DK114388-01 (awarded to Dr. Henderson), and 1K23DK115908-01 (awarded to Dr. Garonzik-Wang). Dr. Snyder is supported under the Scientific Registry of Transplant Recipients contract HHSH250201500009C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation).
Publisher Copyright:
© 2019 by the American Society of Nephrology.
PY - 2019/7/5
Y1 - 2019/7/5
N2 - Background and objectives Hypertension in older kidney donor candidates is viewed as safe. However, hypertension guidelines have evolved and long-term outcomes have not been explored. We sought to quantify the 15-year risk of ESKD and mortality in older donors (≥50 years old) with versus those without hypertension. Design, setting, participants, & measurements A United States cohort of 24,533 older donors from 1999 to 2016, including 2265 with predonation hypertension, were linked to Centers for Medicare and Medicaid Services data and the Social Security Death Master File to ascertain ESKD development and mortality. The exposure of interest was predonation hypertension. From 2004 to 2016, hypertension was defined as documented predonation use of antihypertensive therapy, regardless of systolic BP or diastolic BP; from 1999 to 2003, when there was no documentation of antihypertensive therapy, hypertension was defined as predonation systolic BP ≥140 or diastolic BP ≥90 mm Hg. Results Older donors were 82% white, 6% black, 7% Hispanic, and 3% Asian. The median follow-up was 7.1 years (interquartile range, 3.4–11.1; maximum, 18). There were 24 ESKD and 252 death events during the study period. The 15-year risk of ESKD was 0.8% (95% confidence interval [95% CI], 0.4 to 1.6) for donors with hypertension (mean systolic BP, 138 mmHg) versus 0.2%(95%CI, 0.1 to 0.4) for donors without hypertension (mean systolic BP, 123 mm Hg; adjusted hazard ratio, 3.04; 95% CI, 1.28 to 7.22; P=0.01). When predonation antihypertensive therapy was available, the risk of ESKD was 6.21-fold higher (95% CI, 1.20 to 32.17; P=0.03) for donors using antihypertensive therapy (mean systolic BP, 132 mm Hg) versus those not using antihypertensive therapy (mean systolic BP, 124 mm Hg). There was no significant association between donor hypertension and 15-year mortality (hazard ratio, 1.18; 95% CI, 0.84 to 1.66; P=0.34). Conclusions Compared with older donors without hypertension, older donors with hypertension had higher risk of ESKD, but not mortality, for 15 years postdonation. However, the absolute risk of ESKD was small.
AB - Background and objectives Hypertension in older kidney donor candidates is viewed as safe. However, hypertension guidelines have evolved and long-term outcomes have not been explored. We sought to quantify the 15-year risk of ESKD and mortality in older donors (≥50 years old) with versus those without hypertension. Design, setting, participants, & measurements A United States cohort of 24,533 older donors from 1999 to 2016, including 2265 with predonation hypertension, were linked to Centers for Medicare and Medicaid Services data and the Social Security Death Master File to ascertain ESKD development and mortality. The exposure of interest was predonation hypertension. From 2004 to 2016, hypertension was defined as documented predonation use of antihypertensive therapy, regardless of systolic BP or diastolic BP; from 1999 to 2003, when there was no documentation of antihypertensive therapy, hypertension was defined as predonation systolic BP ≥140 or diastolic BP ≥90 mm Hg. Results Older donors were 82% white, 6% black, 7% Hispanic, and 3% Asian. The median follow-up was 7.1 years (interquartile range, 3.4–11.1; maximum, 18). There were 24 ESKD and 252 death events during the study period. The 15-year risk of ESKD was 0.8% (95% confidence interval [95% CI], 0.4 to 1.6) for donors with hypertension (mean systolic BP, 138 mmHg) versus 0.2%(95%CI, 0.1 to 0.4) for donors without hypertension (mean systolic BP, 123 mm Hg; adjusted hazard ratio, 3.04; 95% CI, 1.28 to 7.22; P=0.01). When predonation antihypertensive therapy was available, the risk of ESKD was 6.21-fold higher (95% CI, 1.20 to 32.17; P=0.03) for donors using antihypertensive therapy (mean systolic BP, 132 mm Hg) versus those not using antihypertensive therapy (mean systolic BP, 124 mm Hg). There was no significant association between donor hypertension and 15-year mortality (hazard ratio, 1.18; 95% CI, 0.84 to 1.66; P=0.34). Conclusions Compared with older donors without hypertension, older donors with hypertension had higher risk of ESKD, but not mortality, for 15 years postdonation. However, the absolute risk of ESKD was small.
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U2 - 10.2215/CJN.14031118
DO - 10.2215/CJN.14031118
M3 - Article
C2 - 31239252
AN - SCOPUS:85069273080
SN - 1555-9041
VL - 14
SP - 1048
EP - 1055
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 7
ER -