Kidney Disease Research Updates
Spring/Summer 2009

Study Evaluates Long-term Consequences of Kidney Donation

Kidney donation appears to have no significant long-term health consequences, according to a study funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The study found donors have a similar survival rate when compared with the general population and a smaller risk of kidney failure, known as end-stage renal disease (ESRD).

“Our study indicates that kidney donors have a normal life span, a health status that is similar to that of the general population, and an excellent quality of life; they do not have an excessive risk of ESRD,” wrote Hassan N. Ibrahim, M.D., associate professor of Medicine, University of Minnesota, and colleagues in their report, which appeared in the January 29, 2009, issue of the New England Journal of Medicine.

Kidney transplantation and dialysis are the only two treatment options for people with kidney failure, the most advanced stage of chronic kidney disease (CKD). CKD has increased 30 percent over the last decade and is most often caused by complications of hypertension and diabetes.

Ongoing Imbalance

Recipients of kidneys from living donors typically have better outcomes than recipients of deceased donor kidneys, who can wait 5 to 7 years for kidney transplantation. Kidney donation from living donors—especially unrelated donors—has increased dramatically over the last decade.

“Given the ongoing imbalance between supply and demand and the trend toward an increasing rate of transplantation from living unrelated donors, it is imperative that the long-term safety and well-being of donors be established,” wrote Jane C. Tan, M.D., Ph.D., assistant professor, Stanford University School of Medicine, and co-author of a companion editorial.

In 2003, researchers began following up on 2,199 out of a possible 3,698 kidney donors who donated kidneys at the University of Minnesota between 1963 and 2007, asking them to report on their health status and, if available, results of kidney function testing. The researchers were able to determine cause of death for 107 of the 268 donors who had died since donating a kidney.

A subset of 255 donors were randomly selected for more extensive follow-up, including kidney function testing, high blood pressure screening, and quality of life assessment. For comparison, a control group, matched for age, race, sex, and body mass index, was selected from the National Health and Nutrition Examination Survey—a periodic survey representative of the nation’s health.

No Greater Risk

Survival rate among donors was similar to that of controls. The estimated incidence of ESRD was lower among donors than controls, and none of the deceased donors had received dialysis or kidney transplantation.

Glomerular filtration rate—a key measure of kidney filtering capacity—was lower among the 255 donors who participated in the more extensive follow-up than controls; however, fewer donors than controls had albuminuria, or protein in the urine, which is a sign of kidney damage. The prevalences of diabetes, hypertension, and cancer were similar among donors and controls. Reported quality of life was higher among donors.

“It is somewhat surprising and quite reassuring that rates of ESRD were lower in kidney donors than in the general population,” wrote Tan, et al. However, most of the donors studied were relatively young and in extremely good health at the time they donated kidneys. “We must be cautious about extrapolating the data from the study of Ibrahim et al. to older donors, who are often spouses or loved ones of affected patients.”

Future studies of kidney donors of various races are needed, as CKD disproportionately affects minorities compared with Caucasians, who represented 99 percent of donors in this study.

The National Kidney and Urologic Diseases Information Clearinghouse, part of the NIDDK, offers free fact sheets and easy-to-read booklets about CKD and kidney transplantation. For more information, visit www.kidney.niddk.nih.gov

NIH Publication No. 09–4531
August 2009

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