Clin Transplant. 2021 Mar 20:e14293. doi: 10.1111/ctr.14293. Online ahead of print.
ABSTRACT
BACKGROUND: The medium to long-term outcomes of living kidney donors with hypertension compared to normotensive donors are not well understood, especially with the recent changes in hypertension guidelines.
METHODS: We studied a cohort of 950 living kidney donors using different definitions of hypertension based on either ≥140/90 or ≥130/80 mmHg thresholds and based on either office or ambulatory blood pressure readings. Microstructural features on kidney biopsy at the time of donation were compared using different definitions of hypertension.
RESULTS: After adjusting for years of follow-up, age, sex, and baseline eGFR, hypertension (by any definition) did not significantly predict an eGFR <45 mL/min/1.73 m2 at a median follow-up of 10 years post-donation, though there was a borderline association with ambulatory blood pressure ≥130/80 mm Hg predicting a 40% decline in eGFR (OR = 1.53, 1.00-2.36; p=0.051). Proteinuria was predicted by office blood pressure ≥140/90 mmHg and by non-dipper profile on nocturnal ambulatory blood pressure measurements. At the time of donation, larger glomeruli and arterial hyalinosis on biopsy associated with hypertension defined by either ≥140/90 or ≥130/80 mmHg (by office or ambulatory measurements). Nocturnal non-dipper status was associated with larger glomeruli size but not arteriolar hyalinosis when compared to dippers.
CONCLUSIONS: In programs that accept donors with controlled hypertension, various definitions of hypertension are associated with histological findings in the donated kidney, but none predict a clinically significant decline in kidney function 10 years after donation. These data support allowing healthy individuals with controlled hypertension to donate a kidney. However, donors with office hypertension (≥140/90 mmHg) and non-dippers (regardless of hypertension status) are at greater long-term risk for proteinuria, and particularly for these donors, longer follow-up is warranted.
PMID:33745214 | DOI:10.1111/ctr.14293
