Addressing the ESRD Risks of the Young Living Kidney Donor: Putting “Normal for Now” into Practice
Abstract
Individuals who are free of traditional clinical risk factors for kidney diseases at the time of living kidney donation have been thought to be at low risk of end-stage renal disease (ESRD) after donor nephrectomy. However, the reassuring low rates of ESRD in available donor follow-up studies have captured only the risks of very rapidly progressing kidney diseases that begin during the study interval, not the higher risks of diabetic ESRD and other slowly evolving diseases that are far more common over a lifetime. The natural histories and age-related characteristics of renal diseases in the general population predict considerable undetected risk, particularly for normal young individuals, who typically will not reach ESRD until late in life. This makes the low long-term absolute risks of ESRD after donation that are suggested by two recent studies problematic. But these studies also suggest an 8–11-fold increased relative risk from donation, which they are well-designed to capture. These relative risks have been attributed to loss of GFR at donor nephrectomy and are consistent with well-accepted GFR-related risks in the general population. These observations indirectly implicate low-normal predonation GFR as an important ESRD risk factor, particularly for young donors. Even if relative risks are half of published estimates, some currently acceptable young donors—especially black donors—will have significantly higher risk for ESRD over their r...
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research
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