Nephrosclerosis beyond That Expected for Age is Predictive of Early New-Onset Hypertension (HTN) in Living Kidney Donors (LKD)

N. Issa,¹ L. Vaughan,¹ A. Denic,¹ V. Nagineni,¹ H. Chakkera,² J. Lieske,¹ L. Lerman,¹ S. Taler,¹ M. Stegall,¹ W. Kremers,¹ E. Poggio,³ A. Rule.¹

¹Mayo Clinic, Rochester, MN
²Mayo Clinic, Scottsdale, AZ
³Cleveland Clinic, Cleveland, OH.

Meeting: 2018 American Transplant Congress

Abstract number: 218

Keywords: Donation, Histology, Hypertension

Session Information

Session Name: Concurrent Session: Kidney Living Donation: Donor and Recipient Outcomes

Session Type: Concurrent Session

Date: Monday, June 4, 2018

Session Time: 2:30pm-4:00pm

Presentation Time: 2:30pm-2:42pm

Location: Room 6E

Background: Nephrosclerosis on biopsy (bx) of LKD is associated with older age & HTN. We studied whether nephrosclerosis is predictive of adverse changes early after donation.

Methods: We studied LKD who had an implantation bx & f/up visit within 1-18 mos.We used age-based bx thresholds for nephrosclerosis derived from a 95% reference limit accounting for age & bx characteristics and included: 1+ criteria,2+ criteria,or a burden score of the following bx variables: Glomerulosclerosis percentage,Cortical fibrosis,Number of fibrosis foci,Arteriosclerosis. Single-& age-based nephrosclerosis thresholds were then assessed as predictors of residual eGFR,40% decline in f/up eGFR,eGFR<60 mL/min/1.73m²,elevated 24-hr albuminuria,& new-onset HTN (defined as SBP>140 or DBP>90 mm Hg or de novo use of anti-hypertensives).

Results: There were 1512 LKD available to define age-based threshold nephrosclerosis of which 1449 had a f/up visit 1-18 mos after donation.After adjusting for clinical predictors,the only baseline characteristic that associated with nephrosclerosis was baseline HTN (p=0.007).After adjusting for age at donation,pre-donation HTN,& f/up time,nephrosclerosis was not predictive of change in eGFR(p=0.37) at f/up,40% decline in f/up eGFR(p=0.37),a f/up eGFR<60 (p=0.92),or change in urine albumin (p=0.70).After excluding baseline HTN & adjusting for age & f/up time, age-based nephrosclerosis was associated with new-onset HTN at f/up: 1+criteria (OR=2.32, p=0.003) & burden score (OR=1.68, p=0.02) respectively as shown in Table 1.

Using single-thresholds rather than age-based thresholds for nephrosclerosis we found an association between the number of fibrosis foci & arterioslerosis with new-onset HTN at f/up (OR=2.36, p=0.04 & OR=4.12, p=0.0007 respectively)as shown in Table 1.

Conclusions: Although uncommon, nephrosclerosis beyond that expected for age in a LKD is associated with both prevalent HTN at donation & new-onset HTN at short-term f/up.

CITATION INFORMATION: Issa N., Vaughan L., Denic A., Nagineni V., Chakkera H., Lieske J., Lerman L., Taler S., Stegall M., Kremers W., Poggio E., Rule A. Nephrosclerosis beyond That Expected for Age is Predictive of Early New-Onset Hypertension (HTN) in Living Kidney Donors (LKD) Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Issa N, Vaughan L, Denic A, Nagineni V, Chakkera H, Lieske J, Lerman L, Taler S, Stegall M, Kremers W, Poggio E, Rule A. Nephrosclerosis beyond That Expected for Age is Predictive of Early New-Onset Hypertension (HTN) in Living Kidney Donors (LKD) [abstract]. https://atcmeetingabstracts.com/abstract/nephrosclerosis-beyond-that-expected-for-age-is-predictive-of-early-new-onset-hypertension-htn-in-living-kidney-donors-lkd/. Accessed November 23, 2024.

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