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Outcomes of Kidney Donors with Impaired Fasting Glucose and Diabetes

S. Hebert, D. T. Nguyen, E. A. Graviss, H. E. Adrogue, A. Gaber, A. Matas, H. Ibrahim

Houston Methodist Hospital, Houston, TX

Meeting: 2020 American Transplant Congress

Abstract number: LB-007

Keywords: Donation, Kidney, Kidney transplantation

Session Information

Session Name: Poster Session A: Late Breaking

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*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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Multivariable risk of diabetes, hypertension, proteinuria, reduced eGFR, and ESRD
FPG 100-125 mg/dL FPG ≥ 126 mg/dL
Outcome Time to event, years n (%) of event aHR (95% CI) p-value n (%) of event aHR (95% CI) p-value
Diabetes 18.3 (±8.6) 62 (11.1) 1.65(1.18, 2.3) 0.003 NA NA NA
Hypertension 18 (±8.8) 155 (54.4) 1.35 (1.10, 1.65) 0.003 22 (57.9) 1.06 (0.63, 1.78) 0.83
Proteinuria 17.2 (±9.6) 73 (14.1) 0.79 (0.59, 1.07) 0.13 8 (10.96) 0.75 (0.35, 1.64) 0.48
eGFR <30 23.3 (±9.7) 7 (2.2) 0.63 (0.21, 1.91) 0.41 4 (8.2) 2.54 (0.62, 10.46) 0.20
ESRD 20.9 (±8.7) 7 (1.2) 1.06 (0.28, 4.01) 0.93 3 (3.5) 5.36 (1.07, 27.01) 0.04
eGFR<30 or ESRD 22.9 (±9.5) 9 (2.8) 0.66 (0.25, 1.77) 0.41 4 (8.0) 1.51 (0.41, 5.60) 0.54
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To cite this abstract in AMA style:

Hebert S, Nguyen DT, Graviss EA, Adrogue HE, Gaber A, Matas A, Ibrahim H. Outcomes of Kidney Donors with Impaired Fasting Glucose and Diabetes [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-kidney-donors-with-impaired-fasting-glucose-and-diabetes/. Accessed May 11, 2025.

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