*Purpose: There is limited knowledge regarding the long-term renal outcomes in hypertensive LKDs. We performed a multicenter study assessing long-term outcomes with or without HTN at the time of donation using emerging definitions with both office and ambulatory BP (ABP) readings.

*Methods: We prospectively followed LKDs from 1999 to 2012. We studied all donors who completed the survey or had clinical follow-up between 2017 and 2019. Different definitions of HTN were assessed: h/o of HTN (HxHTN) was defined as a kidney donor with a diagnosis of HTN prior to donor evaluation; antihypertensive medications use (antiHTN meds). Office HTN was defined as having HxHTN or taking antiHTN meds or having office BP ≥ 140/90 (JNC7) or ≥ 130/80 (ACC/AHA 2017). Ambulatory Blood Pressure Monitoring (ABPM) HTN was defined as having HxHTN or taking antiHTN meds or an Active (daytime) ABPM > 135/85 (JNC7) or > 130/80 (ACC/AHA 2017). A non-dipper was defined as the ratio of mean nocturnal and active ABPM greater than 90% for systolic or diastolic readings. Renal outcomes were eGFR<45, 40% decline in eGFR, or proteinuria. Logistic regression was used for analysis, unadjusted and adjusted for age, sex, follow-up time.

*Results: A total of 918 kidney donors who had ABPM were analyzed with a mean 10.6 years of follow-up. As seen in Table 1, none of the HTN definitions and types of measurements were predictor for eGFR<45 ml/min or a 40% decline in eGFR. History of taking antiHTN meds and office HTN by JNC7 predicted proteinuria in the adjusted model. Nondipper status also predicted proteinuria (OR=2.4, p=0.034).

*Conclusions: We did not detect a long-term risk for clinically significant reductions in GFR among hypertensive donors using different definitions of HTN. However, given the increased risk for proteinuria among hypertensive LKDs, longer follow-up is needed to determine its potential clinical impact.

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