We examined a novel linkage of Organ Procurement and Transplant Network (OPTN) registry data for prior living kidney donors (LKDs) with Medicare billing claims to study racial variation in post-donation diagnoses of hypertension (HTN), diabetes (DM), chronic kidney disease (CKD) and sub-classifications of these conditions. Diagnosis patterns according to race were compared with findings from a prior linkage of OPTN data and private payer claims.

Donors in the Medicare sample (n=4,007) had OPTN records of serving as a LKD in 1987-2008 and post-nephrectomy medical benefits at some point in the available claims (2004-2008). Of these, 40% were men, 8% were black and 5.7% Hispanic. HTN diagnoses were substantially more common in the Medicare vs privately-insured LKDs (66% vs 18% at 5yrs) but were predominantly classified as benign and unspecified. 5-yr frequencies of other conditions in the Medicare vs privately-insured LKDs included: malignant HTN, 5% vs 0.9%; DM, 18.5% vs 4.1%; CKD, 22% vs 5%, and proteinuria, 5% vs 2%.

In multivariate regression including adjustment for donor age and gender, black race was associated with higher relative risks (RR) of all categories of HTN after donation in the Medicare sample, with strongest association for malignant HTN (aHR 2.4) (Table). Hispanic LKDs in Medicare also had twice the RR of malignant HTN. Black LKDs in Medicare had ∼50% higher RR of DM than whites, and Hispanic donors had twice the RR. Black LKDs in Medicare had twice the likelihood of CKD diagnoses and 2.4-times the RR of proteinuria. Similar patterns for black vs white race were seen in the privately-insured LKDs. Patterns of RR according to race were similar in sensitivity analyses with censoring of early Medicare entry before age 65.

While diagnoses of HTN, DM and CKD are more common among Medicare-insured compared to privately-insured prior LKDs, racial variation in diagnosis rates is consistent regardless of sample/payer source. Focused attention to the mediators and consequences of long-term medical outcomes among non-white LKDs is needed.

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