Kidney Week

Abstract: SA-PO099

Postdonation Renal Function Predicts New Onset Antihypertensive Medication Use After Living Kidney Donation

Session Information

• Transplantation: Recipient and Donor Assessment
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States

Krista L. Lentine,

• Naik, Abhijit S., University Michigan, Ann Arbor, Michigan, United States

Abhijit S. Naik,

• Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada

Ngan Lam,

• Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada

Amit X. Garg,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

• Axelrod, David A., Lahey Hospital and Clinic, Burlington, Massachusetts, United States

David A. Axelrod,

• Xiao, Huiling, St. Louis University, St. Louis, Missouri, United States

Huiling Xiao,

• Henderson, Macey L., Johns Hopkins, Baltimore, Maryland, United States

Macey L. Henderson,

• Massie, Allan, Johns Hopkins School of Medicine, Baltimore, Maryland, United States

Allan Massie,

• Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States

Chi-yuan Hsu,

• Kasiske, Bertram L., Hennepin County Medical Center, Minneapolis, Minnesota, United States

Bertram L. Kasiske,

• Hess, Gregory P., LDI University of Pennsylvania/Symphony Health, Conshohocken, Pennsylvania, United States

Gregory P. Hess,

• Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States

Mark Schnitzler,

Background

Limited data are available on the outcome implications of renal function after living kidney donation.

Methods

We constructed a novel database linking SRTR registry identifiers, serum creatinine (SCr) values from an electronic medical records warehouse, and pharmacy fill records for 3,593 living kidney donors (1989–2016) without predonation hypertension per the registry. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m2) was computed from SCr by the CKD-EPI equation. Pharmacy enrollment was assessed within ±90 days of each postdonation SCr, followed by identification of antihypertensive medication (AHM) fills in those with pharmacy records eligibility. A mixed effects model was constructed to assess associations of postdonation eGFR (adjusted odds ratio, _95%LCL aOR _{95% UCL}) and other baseline factors with AHM treatment requirements after donation.

Results

The linked database captured an average of 3 post-donation SCr values per donor (range: 1 to 38). Lower postdonation eGFR bore a graded association with increased AHM use (eGFR 30–44: aOR _0.951.47_2.26; <30: aOR _1.08 5.90_2.52). Other significant (P<0.05) correlates of postdonation AHM fills included black race (aOR 2.22), BMI >30 kg/m² (aOR 2.09), first-degree donor-recipient relationship (aOR 1.79), “pre-hypertension" at donation (SBP 120-139: aOR 1.94; DBP 80-89: aOR 1.99), and longer time since donation. Predonation eGFR was not significantly associated with AHM use in the multi-level model. [Fig.]

Conclusion

Lower eGFR levels after living kidney donation are associated with need for AHM treatment. Further work should define relationships of postdonation renal function with renal and cardiovascular morbidity.

Funding

• NIDDK Support