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Risk of end-stage renal disease following live kidney donation.
Muzaale, Abimereki D; Massie, Allan B; Wang, Mei-Cheng; Montgomery, Robert A; McBride, Maureen A; Wainright, Jennifer L; Segev, Dorry L.
Afiliação
  • Muzaale AD; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Massie AB; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Wang MC; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
  • Montgomery RA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • McBride MA; United Network for Organ Sharing, Richmond, Virginia.
  • Wainright JL; United Network for Organ Sharing, Richmond, Virginia.
  • Segev DL; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland2Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland4Department of Epidemiology, Johns Hopkins Bloomberg School of Public.
JAMA ; 311(6): 579-86, 2014 Feb 12.
Article em En | MEDLINE | ID: mdl-24519297
IMPORTANCE: Risk of end-stage renal disease (ESRD) in kidney donors has been compared with risk faced by the general population, but the general population represents an unscreened, high-risk comparator. A comparison to similarly screened healthy nondonors would more properly estimate the sequelae of kidney donation. OBJECTIVES: To compare the risk of ESRD in kidney donors with that of a healthy cohort of nondonors who are at equally low risk of renal disease and free of contraindications to live donation and to stratify these comparisons by patient demographics. DESIGN, SETTINGS, AND PARTICIPANTS: A cohort of 96,217 kidney donors in the United States between April 1994 and November 2011 and a cohort of 20,024 participants of the Third National Health and Nutrition Examination Survey (NHANES III) were linked to Centers for Medicare & Medicaid Services data to ascertain development of ESRD, which was defined as the initiation of maintenance dialysis, placement on the waiting list, or receipt of a living or deceased donor kidney transplant, whichever was identified first. Maximum follow-up was 15.0 years; median follow-up was 7.6 years (interquartile range [IQR], 3.9-11.5 years) for kidney donors and 15.0 years (IQR, 13.7-15.0 years) for matched healthy nondonors. MAIN OUTCOMES AND MEASURES: Cumulative incidence and lifetime risk of ESRD. RESULTS: Among live donors, with median follow-up of 7.6 years (maximum, 15.0), ESRD developed in 99 individuals in a mean (SD) of 8.6 (3.6) years after donation. Among matched healthy nondonors, with median follow-up of 15.0 years (maximum, 15.0), ESRD developed in 36 nondonors in 10.7 (3.2) years, drawn from 17 ESRD events in the unmatched healthy nondonor pool of 9364. Estimated risk of ESRD at 15 years after donation was 30.8 per 10,000 (95% CI, 24.3-38.5) in kidney donors and 3.9 per 10,000 (95% CI, 0.8-8.9) in their matched healthy nondonor counterparts (P < .001). This difference was observed in both black and white individuals, with an estimated risk of 74.7 per 10,000 black donors (95% CI, 47.8-105.8) vs 23.9 per 10,000 black nondonors (95% CI, 1.6-62.4; P < .001) and an estimated risk of 22.7 per 10,000 white donors (95% CI, 15.6-30.1) vs 0.0 white nondonors (P < .001). Estimated lifetime risk of ESRD was 90 per 10,000 donors, 326 per 10,000 unscreened nondonors (general population), and 14 per 10,000 healthy nondonors. CONCLUSIONS AND RELEVANCE: Compared with matched healthy nondonors, kidney donors had an increased risk of ESRD over a median of 7.6 years; however, the magnitude of the absolute risk increase was small. These findings may help inform discussions with persons considering live kidney donation.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Transplante de Rim / Doadores Vivos / Coleta de Tecidos e Órgãos / Falência Renal Crônica Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2014 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Transplante de Rim / Doadores Vivos / Coleta de Tecidos e Órgãos / Falência Renal Crônica Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2014 Tipo de documento: Article