Research suggests that the long-term health of LKD is comparable to the general population. However, there are limited comprehensive studies for this population and the composition of LKD has changed over the past decades. Our aim was to evaluate short-term (first year) changes in renal function among LKD in the US in order to identify those that may be at higher risk for renal complications. Methods: We utilized national SRTR data for LKD in the US (2004-2011). The primary outcomes were changes in serum creatinine and estimated GFR between pre-donation and one-year post-donation. We utilized multivariable linear regression models to evaluate factors significantly associated with changes in renal function. Results: The median change in creatinine and eGFR from pre- to one-year post-donation was +0.3mg/dL (40% increase) and -28.5mL/min/1.73kg/m² (-33% decline) respectively. Changes in creatinine levels were highest among African Americans (+0.36mg/dL), Asians(+0.33mg/dL), and Native Americans(+0.36mg/dL) which were statistically significantly higher than Caucasians(+0.31mg/dL) and Hispanics(+0.30mg/dL). Older LKD had greater increases in creatinine levels (+0.37mg/dL for LKD>50yo vs 0.32mg/dL for LKD<=50yo) as did men as compared to women (+0.38mg/dL vs 0.30mg/dL,p<0.001). There was no association in changes based on pre-donation BMI (p=0.09) and pre-donation blood pressure (diastolic p=0.53, systolic p=0.94). Results were consistent for eGFR with exception of no statistically significant association by gender. There was a statistically significant trend for greater declines in renal function in more recent years (adjusted change in eGFR in 2004=-24.9 ml/min as compared to -29.9 ml/min in 2010, p<0.001). The overall proportion of LKD with eGFR<60 ml/min/1.73m2 prior to donation was 3.7% which increased to 46.8% at one year post-donation. The proportion of LKD with eGFR<60 ml/min/1.73m2 was highest among Caucasians (54%) and LKD over the age of 50 (66%). Discussion: Changes in first year renal function among LKD are significantly impacted by demographic characteristics. The degree to which early changes are associated with long-term outcomes will require more extensive follow up. The more rapid declines of renal function in recent years also warrants careful investigation. The true clinical significance of a eGFR<60 ml/min/1.73m2 in LKD is unclear.

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