Every year, over 6000 healthy individuals donate a kidney in the United States to benefit a loved one or even a stranger. Currently, approximately 100,000 individuals are living post-nephrectomy. Live kidney donors gain no medical benefit from donation, nor do they expect to. However, live donors do expect the medical community to understand the long-term risks of kidney donation, for the purposes of donor selection, informed consent, and post-donation care. For African American kidney donors, we have thus far failed in this regard. The largest cohort study of kidney donors, from which the transplant community's assessment of the safety of kidney donation has been primarily derived, was comprised of less than 1% African American donors. Yet 13% of live donors in the US are African American, and our preliminary findings suggest that rates of death, hypertension, chronic kidney disease, and end-stage renal disease following donation are significantly higher in African Americans. It is critical to not only estimate the risk of these diseases, but to understand the risk attributable t donation;however, no study to date has captured appropriate non-donor controls that are necessary for this estimation. Furthermore, many African American donors, particularly young donors, have limited access to healthcare, and it is important to elucidate potential disparities i the management of post- donation consequences such as hypertension and decline in kidney function. In light of a significant knowledge gap regarding long-term outcomes and medical care following kidney donation in African Americans, we propose to estimate the incidence and consequences of hypertension and kidney disease in African American versus Caucasian donors. More importantly, we will determine how much of that risk is attributable to donating a kidney (rather than population-based differences in underlying risk) by comparing donors to healthy non-donors. We will also evaluate the reliability of administrative data sources in capturing and studying post-donation morbidity, and seek to better understand racial differences in treatment patterns for donors who develop hypertension or chronic kidney disease. We will accomplish these goals by recruiting the largest primary cohort of African American donors (over 4000 donors from the top 13 centers in the US), a comparison cohort of Caucasian donors, and healthy non-donors who met eligibility criteria for donation but did not actually donate. We will supplement these cohort with linkage of national registry data to Medicare, Medicaid, and private payer claims and pharmacy data. Our findings will have a direct impact on the practice of live kidney donation among African Americans in the US, informing critical aspects of donor selection, informed consent for donation, and post-donation care. In addition, this research will create an important resource from which several future ancillary projects are foreseeable, including genotyping to risk stratify potential donors, evaluating the effects of acut kidney injury and nephrotoxic drugs after donation, and estimating lifetime healthcare costs and utilization for kidney donors.

Public Health Relevance

Every year, over 6000 healthy individuals donate a kidney to benefit a loved one or even a stranger, but the long-term consequences of donating a kidney, particularly in African Americans, are poorly understood. In this study, we will study high blood pressure, chronic kidney disease, and post-donation treatment patterns in largest ever primary cohort of African American donors, Caucasian American donors, matched healthy non-donor controls (who were cleared for donation but did not ultimately donate because of recipient factors), and other matched healthy individuals (who participated in large cohort studies and were deemed healthy enough to have likely passed a donor evaluation). Our findings will influence the practice of live kidney donation in the United States, particularly among African Americans, informing critical aspects of donor selection, informed consent for donation, and post-donation care.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
3R01DK096008-02S1
Application #
8915850
Study Section
Special Emphasis Panel (ZRG1-HSOD-J (09))
Program Officer
Kusek, John W
Project Start
2013-05-02
Project End
2018-04-30
Budget Start
2014-05-01
Budget End
2015-04-30
Support Year
2
Fiscal Year
2014
Total Cost
$72,406
Indirect Cost
$27,711
Name
Johns Hopkins University
Department
Surgery
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
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Lam, Ngan N; Lentine, Krista L; Garg, Amit X (2014) End-stage renal disease risk in live kidney donors: what have we learned from two recent studies? Curr Opin Nephrol Hypertens 23:592-6
Lentine, Krista L; Schnitzler, Mark A; Garg, Amit X et al. (2014) Understanding antihypertensive medication use after living kidney donation through linked national registry and pharmacy claims data. Am J Nephrol 40:174-83
Lentine, Krista L; Schnitzler, Mark A; Xiao, Huiling et al. (2014) Consistency of racial variation in medical outcomes among publicly and privately insured living kidney donors. Transplantation 97:316-24
Lentine, Krista L; Segev, Dorry L (2013) Better understanding live donor risk through big data. Clin J Am Soc Nephrol 8:1645-7