Increased Risk of Ischaemic Heart Disease After Kidney Donation

Anders J. Haugen; Stein Hallan; Nina E. Langberg; Dag Olav Dahle; Hege Pihlstrøm; Kåre I. Birkeland; Anna V. Reisæter; Karsten Midtvedt; Anders Hartmann; Hallvard Holdaas; Geir Mjøen

Disclosures

Nephrol Dial Transplant. 2022;37(5):928-936. 

In This Article

Abstract and Introduction

Abstract

Background: Previous reports suggest increased risk of hypertension and cardiovascular mortality after kidney donation. In this study we investigate the occurrence of ischaemic heart disease and cerebrovascular disease, diabetes and cancer in live kidney donors compared with healthy controls eligible for donation.

Methods: Different diagnoses were assessed in 1029 kidney donors and 16 084 controls. The diagnoses at follow-up were self-reported for the controls and registered by a physician for the donors. Stratified logistic regression was used to estimate associations with various disease outcomes, adjusted for gender, age at follow-up, smoking at baseline, body mass index at baseline, systolic blood pressure at baseline and time since the donation.

Results: The mean observation time was 11.3 years [standard deviation (SD) 8.1] for donors versus 16.4 years (SD 5.7) for controls. The age at follow-up was 56.1 years (SD 12.4) in donors versus 53.5 years (SD 11.1) in controls and 44% of donors were males versus 39.3% in the controls. At follow-up, 35 (3.5%) of the donors had been diagnosed with ischaemic heart disease versus 267 (1.7%) of the controls. The adjusted odds ratio for ischaemic heart disease was 1.64 (confidence interval 1.10–2.43; P = 0.01) in donors compared with controls. There were no significant differences for the risks of cerebrovascular disease, diabetes or cancer.

Conclusions: During long-term follow-up of kidney donors, we found an increased risk of ischaemic heart disease compared with healthy controls. This information may be important in the follow-up and selection process of living kidney donors.

Introduction

Kidney transplantation from a live donor is the best available treatment for end-stage kidney disease.[1]

Although live kidney donation is beneficial to the recipient, it may not be without risks for the individual who donates. A known consequence following a donor nephrectomy is an immediate reduction in glomerular filtration rate (GFR), followed by a slow compensatory increase before GFR slowly declines.[2] Previous meta-analyses and several studies[3–7] suggest that living donors have increased blood pressure (BP) and proteinuria after donation. Proteinuria, hypertension and reduced renal function are all risk factors for the development of cardiovascular disease.[8–12]

Interpretation of earlier publications has been complicated by inappropriate control groups from the general population, small sample sizes and short follow-up.[13–19]

We have previously shown a relative risk (RR) increase of 40% for cardiovascular mortality in donors compared with healthy controls.[20] To further evaluate risk following kidney donation we now report the results from a national observational study of >1000 living donors evaluating long-term risks for ischaemic heart disease, cerebrovascular disease, diabetes and cancer after donation. For comparison, a healthy control population was selected who fulfilled similar standard donation criteria and were evaluated during similar time periods as the donors.

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