*Purpose: Many kidney donor candidates with impaired fasting glucose (IFG) and all candidates with diabetes (DM) are excluded from donation. The diagnostic thresholds for IFG and DM have changed. Therefore, many donors from earlier eras donated when their fasting glucose was ≥126 mg/dL fulfilling the diabetes (DM) diagnosis threshold.

*Methods: We ascertained vital status, proteinuria, reduced glomerular filtration rate (GFR) and end-stage renal disease (ESRD) in 8280 ethnically diverse kidney donors from 1963-2007 according to fasting plasma glucose (FPG) at donation representing the current American Diabetes Association definitions for normoglycemia, IFG and DM; <100 mg/dL (n=6204), 100-125 mg/dL (n=1826), ≥126 mg/dL (n=250), respectively. Both Cox proportional and logistic regression models were used to estimate outcome risks.

*Results: After a mean follow-up of 7.4 ± 10.1 years, 4.4% of donors died and 29.4% developed hypertension. IFG was associated with a higher risk of diabetes; aHR 1.65 (1.18-2.30) and hypertension; aHR 1.35 (1.10-1.65), p = 0.003 for both. Donors with IFG had no increased risk of proteinuria or ESRD. Donors with FPG ≥126mg/dL were at higher risk for mortality but not for reduced eGFR or proteinuria. In total, 41 (0.5%) donors developed ESRD; 3/250 in donors with FPG ≥126 mg/dL; aHR 5.36 (1.07-27.01) in the Cox model, and aOR 4.09 (1.11-15.11) in the logistic regression model; p = 0.04 for both. The risk of ESRD in donors with IFG was not increased.

*Conclusions: IFG at donation is associated with an increased risk of diabetes and hypertension but not death, proteinuria, or ESRD. ESRD developed in 1.2% of donors with DM; a risk that appears to be similar to those with DM and two kidneys.

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