|Title||Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate.|
|Publication Type||Journal Article|
|Year of Publication||2016|
|Authors||Grams 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 Authors||Garg AX|
|Corporate Authors||Chronic Kidney Disease Prognosis Consortium|
|Journal||N Engl J Med|
|Date Published||2016 Feb 04|
|Keywords||Adult, 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|
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.).
|Alternate Journal||N Engl J Med|
|PubMed Central ID||PMC4758367|
|Grant List||HHSN268201100012C / 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