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Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate.

TitleKidney-Failure Risk Projection for the Living Kidney-Donor Candidate.
Publication TypeJournal Article
Year of Publication2016
AuthorsGrams ME, Sang Y, Levey AS, Matsushita K, Ballew S, Chang AR, Chow EKH, Kasiske BL, Kovesdy CP, Nadkarni GN, Shalev V, Segev DL, Coresh JJ, Lentine KL
Secondary AuthorsGarg AX
Corporate AuthorsChronic Kidney Disease Prognosis Consortium
JournalN Engl J Med
Volume374
Issue5
Pagination411-21
Date Published2016 Feb 04
ISSN1533-4406
KeywordsAdult, Aged, Female, Glomerular Filtration Rate, Humans, Hypertension, Incidence, Kidney Failure, Chronic, Kidney Transplantation, Living Donors, Male, Middle Aged, Models, Statistical, Risk Assessment, Risk Factors, Sex Factors, United States
Abstract

BACKGROUND: Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney.

METHODS: We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States.

RESULTS: A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation.

CONCLUSIONS: Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).

DOI10.1056/NEJMoa1510491
Alternate JournalN Engl J Med
PubMed ID26544982
PubMed Central IDPMC4758367
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
K23 DK106515 / DK / NIDDK NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
K08DK092287 / DK / NIDDK NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
R01 DK096008 / DK / NIDDK NIH HHS / United States
R01DK100446-01 / DK / NIDDK NIH HHS / United States
R01DK096008 / DK / NIDDK NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
K08 DK092287 / DK / NIDDK NIH HHS / United States
R01 DK100446 / DK / NIDDK NIH HHS / United States