Kidney-failure risk projection for the living kidney-donor candidate

Background — The evaluation of candidates for living kidney donation relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person’s likely long-term risk of ESRD in the absence of donation.

Methods — We used meta-analyzed risk associations from 7 general population cohorts, calibrated to US population-level incidence of ESRD and mortality, to project the estimated long-term incidence of ESRD in the absence of donation according to 10 demographic and health characteristics. We then compared 15-year projections to observed risk among recent US living kidney donors (N=52,998).

Results — There were 4,933,314 participants followed a median of 4 to 16 years. For a 40-year-old person with health characteristics similar to agematched kidney donors, the 15-year ESRD risk projections in the absence of donation varied by race and sex: 0.24%, 0.15%, 0.06%, and 0.04% in black men, black women, white men, and white women. Risk projections were higher in the presence of lower estimated glomerular filtration rate, higher albuminuria, hypertension, smoking, diabetes, and obesity. In the model-based lifetime projections, ESRD risk was highest at younger age, particularly among African Americans. Risk projections in the absence of donation were 3.5-5.3-fold lower than 15-year observed risk post-donation in US kidney donors.

Conclusions — We suggest multiple health characteristics be considered together to estimate long-term ESRD risk for living kidney donor candidates. This approach can improve the evaluation, counseling and acceptance of living kidney donor candidates.