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New online tool better estimates risk in living kidney donors, opens doors to healthy older donors

November 6, 2015 London

Healthy older people have a lower risk of developing kidney failure in their lifetime compared to younger people, and may make good candidates to be living kidney donors says a large new study examining kidney donor health risk.

Participating in the study was Ontario researcher Dr. Amit Garg who leads the Kidney, Dialysis and Transplantation Research Program at the Institute for Clinical Evaluative Sciences (ICES) as well as the ICES Western facility at Lawson Health Research Institute in London, Ontario.

“This large and robust analysis demonstrates the importance of exercising caution when approving young living kidney donors when they are obese, smoke or have other risk factors,” says Dr. Garg. “By modeling the projected lifetime risk of kidney failure according to multiple baseline characteristics, we can provide physicians with a better tool to assess the suitability of living donor candidates than what has been used to date.”

As reported today in the New England Journal of Medicine, the research consortium looked at data from nearly 5 million Americans and Canadians who participated in seven large studies to project the long-term incidence of kidney failure in people with two kidneys. The study included data from ICES.

Using this very large data set, the consortium identified 10 routinely available demographic and health characteristics that can work together to predict future kidney failure, including such factors as age, race, gender, hypertension, smoking and obesity. They then developed an online risk assessment tool to help estimate a living kidney donor’s chance of developing kidney failure over the following 15 years and the remainder of his or her lifetime. Previous risk assessments have generally examined only one health characteristic at a time.

While kidney donation likely increases the risk of developing kidney failure (since donors are left with one kidney instead of two) it is hard to predict by how much. The new tool quantifies overall risk before donation, letting physicians know which potential organ donors are more at risk of developing kidney problems, even if they do not donate.

While some healthy older people may make good donors, the online tool suggests that younger people – who are expected to live longer with a single kidney – are at greater risk of developing kidney failure during their lifetime. Race is also a consideration when evaluating donor candidates, since the risk of end-stage renal disease is higher for people who are black, compared to those who are white.

“Currently, approximately 30,000 people donate a kidney worldwide each year, while in the US alone, more than 120,000 patients with kidney failure are awaiting transplants,” says Dr. Garg. “By extending kidney donation to a larger number of older living donors who may previously have been excluded from consideration, and by examining risk factors in combination rather than in isolation, this new approach to assessing risk in living kidney donors may open the door to higher rates of successful transplantations, improving outcomes for both the recipients and the donors.”

The tool can be found at  www.transplantmodels.com/esrdrisk

This tool and research is featured in Kidney Disease Improving Global Outcomes (KDGIO) new international clinical practice guidelines in living kidney donation. These guidelines were co-chaired by Drs. Garg and Krista Lentine and were also released today for public review.

“Kidney Failure Risk Projection for the Living Kidney Donor Candidate” was published today in the New England Journal of Medicine.

Author block:  Morgan Grams, Yingying Sang, Andrew Levey, Kunihiro Matsushita, Shoshana Ballew, Alex Chang, Eric Chow, Bertram Kasiske, Csaba Kovesdy, Girish Nadkarni, Varda Shalev, Dorry Segev, Josef Coresh, Krista Lentine, Amit X. Garg.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

Lawson Health Research Institute (Lawson) is the research institute of London Health Sciences Centre and St. Joseph's Health Care London, and works in partnership with Western University.  Lawson is committed to furthering scientific knowledge to advance health care around the world. www.lawsonresearch.com

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