Postdonation eGFR and New-Onset Antihypertensive Medication Use After Living Kidney Donation

Krista L Lentine; Courtenay M Holscher; Abhijit S Naik; Ngan N Lam; Dorry L Segev; Amit X Garg; David Axelrod; Huiling Xiao; Macey L Henderson; Allan B Massie; Bertram L Kasiske; Gregory P Hess; Chi-Yuan Hsu; Meyeon Park; Mark A Schnitzler

doi:10.1097/TXD.0000000000000913

Postdonation eGFR and New-Onset Antihypertensive Medication Use After Living Kidney Donation

Transplant Direct. 2019 Jul 25;5(8):e474. doi: 10.1097/TXD.0000000000000913. eCollection 2019 Aug.

Authors

Affiliations

¹ Saint Louis University, St. Louis, MO.
² Johns Hopkins University, Baltimore, MD.
³ University of Michigan, Ann Arbor, MI.
⁴ University of Alberta, Edmonton, AB, Canada.
⁵ Western University, London, ON, Canada.
⁶ University of Iowa, Iowa City, IA.
⁷ Hennepin Healthcare, Minneapolis, MN.
⁸ University of Pennsylvania, Philadelphia, PA.
⁹ University of California, San Francisco, San Francisco, CA.

Abstract

Background: Limited data are available regarding clinical implications of lower renal function after living kidney donation. We examined a novel integrated database to study associations between postdonation estimated glomerular filtration rate (eGFR) and use of antihypertensive medication (AHM) treatment after living kidney donation.

Methods: Study data were assembled by linking national U.S. transplant registry identifiers, serum creatinine (SCr) values from electronic medical records, and pharmacy fill records for 3222 living donors (1989-2016) without predonation hypertension. Estimated GFR (mL/min per 1.73 m²) was computed from SCr values by the CKD-EPI equation. Repeated measures multivariable mixed effects modeling examined the associations (adjusted odds ratio, _95%LCLaOR_{95% UCL}) between AHM use and postdonation eGFR levels (random effect) with fixed effects for baseline donor factors.

Results: The linked database identified an average of 3 postdonation SCr values per donor (range: 1-38). Lower postdonation eGFR (vs ≥75) bore graded associations with higher odds of AHM use (eGFR 30-44: aOR _0.951.47_2.26; <30: aOR _1.082.52_5.90). Other independent correlates of postdonation AHM use included older age at donation (aOR per decade: _1.081.23_1.40), black race (aOR _1.031.51_2.21), body mass index > 30 kg/m² (aOR _1.011.45_2.09), first-degree donor-recipient relationship (aOR _1.071.38_1.79), "prehypertension" at donation (systolic blood pressure 120-139: aOR _1.101.46_1.94; diastolic blood pressure 80-89: aOR _1.061.45_1.99).

Conclusions: This novel linkage illustrates the ability to identify postdonation kidney function and associate it with clinically meaningful outcomes; lower eGFR after living kidney donation is a correlate of AHM treatment requirements. Further work should define relationships of postdonation renal function, hypertension, and other morbidity measures.