Donor eGFR declines sharply after living kidney donation, but long-term eGFR trajectories and their relationship to post-donation hypertension are poorly understood.

METHODS: We retrospectively obtained 7805 post-donation serum creatinine values from medical records of 950 living donors from our center with median (IQR) followup 4.8 (1.6-9.0, max 29.4) y, and calculated eGFR using the CKD-EPI equation. We modeled eGFR trajectory using multilevel mixed-effects linear regression, accounting for individual variation in initial post-donation eGFR (random intercept) and eGFR trajectory (random slope).

RESULTS: Initial post-donation eGFR was lower in donors who were male, older, or African-American (AA), and higher in donors with higher pre-donation eGFR (Table). Greater BMI was associated with higher eGFR below BMI=28; above 28, the association was not statistically significant. eGFR increased by mean 2.6 per year in female donors and 5.7 per year in male donors (interaction p<0.001, Figure). However, eGFR declined over time for 23% of donors. Among donors without history of pre-donation hypertension, 19.8% of donors whose eGFR declined over time had incident post-donation hypertension (vs 9.9% of donors whose eGFR increased, [chi]² p<0.01). The association between eGFR decline and post-donation hypertension persisted after adjusting for age, sex, race, and BMI (OR=_1.3 2.2 _3.9, p<0.01).

CONCLUSIONS: Following initial post-donation decline, eGFR increases over time in most living kidney donors, particularly male donors. However, donors with decline in post-donation eGFR over time should be monitored closely for hypertension and counseled about risk.

CITATION INFORMATION: Massie A, Muzaale A, Anjum S, Leanza J, Alejo J, Locke J, Segev D. Post-Donation eGFR and Hypertension in Living Kidney Donors. Am J Transplant. 2016;16 (suppl 3).

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