Gestational hypertension and preeclampsia in living kidney donors
Garg AX, Nevis IF, McArthur E, Sontrop JM, Koval JJ, Lam NN, Hildebrand AM, Reese PP, Storsley L, Gill JS, Segev DL, Habbous S, Bugeja A, Knoll GA, Dipchand C, Monroy-Cuadros M, Lentine, KL. N Engl J Med. 2015; 372(2):124-33. Epub 2014 Nov 14.
Background — Young women wishing to become a living kidney donor frequently ask whether nephrectomy will affect their future pregnancies.
Methods — The researchers conducted a retrospective cohort study of living kidney donors (85 women, 131 pregnancies in follow-up) matched (1:6) to healthy non-donors from the general population (510 women, 788 pregnancies). Donations occurred between 1992 and 2009 in Ontario, Canada, with follow-up through linked healthcare databases until March 2013. Donors and non-donors were matched on age, year of cohort entry, residency (urban or rural), income, number of childbirths prior to cohort entry, and the time to first pregnancy after cohort entry. The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia. Secondary outcomes included each component of the primary outcome examined separately and other maternal and fetal outcomes.
Results — A hospital diagnosis of gestational hypertension or preeclampsia was more common among living kidney donors compared with non-donors (15/131 [11.5%] vs. 38/788 [4.8%]; odds ratio 2.4 [95% 1.2 to 5.0]; P=0.01). The odds of each component outcome were also two-fold higher (2.5 and 2.4, respectively). Donors and non-donors did not differ statistically on pre-term birth (< 37 weeks gestation; 7.6% vs. 6.6%) or low birth weight (< 2500 g; 6.1% vs. 3.9%). No donor experienced a maternal death, stillbirth, or neonatal death.
Conclusions — Compared with carefully matched non-donors of similar baseline health, living kidney donors were more likely to be diagnosed with gestational hypertension or preeclampsia. Most women had uncomplicated pregnancies after donation.
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Kidney and urinary tract disorders