This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Kidney donation from living donors has been encouraged as a means of alleviating the shortage of kidneys for transplantation. The procedure has been widely accepted based on a fairly strong body of literature, with multiple studies demonstrating lack of long- term adverse health effects of unilateral nephrectomy performed on a healthy individual. However, long-term safety has not been demonstrated with live kidney donation from individuals with a more- than-minimal risk for development of chronic kidney disease (CKD), and there is reason for concern in non-ideal donors. Rats have been shown to develop hypertension (HTN), proteinuria, glomerular hyperfiltration and chronic renal failure after subtotal nephrectomy; and it appears that similar sequelae may ensue in humans who lose a critical mass of nephrons. Furthermore, unilateral nephrectomy has been shown to accelerate the progression of an underlying renal disease in diabetic and hypertensive rats. There are many reasons to believe that African American living kidney donors (AALKD's) may be at higher risk for adverse long-term renal complications from unilateral nephrectomy. Numerous studies have demonstrated higher risk of HTN, CKD (especially due to HTN), and end-stage renal disease (ESRD) in African-Americans as compared to Caucasians. An analysis of National Health & Nutrition Survey (NHANES) II data found that the relative risk (RR) of all cause CKD was 2.7 times higher among African Americans compared with whites, especially among those 30 - 59 years of age (RR 4.23). With the incidence curve showing a fairly sharp rise in the mid 40's and the typical onset of essential hypertension in the 30's, it is clear that individuals who are destined to later develop such problems may escape identification in the pre-donation work up, potentially setting up many AALKD's for significant morbidity at an unacceptably young age as a result of kidney donation. Prior studies that have been cited to support the long-term safety of unilateral nephrectomy do not provide sufficient data to assure safety in AALKD's. No race-specific evaluation of long-term renal outcomes has been included in these studies. Live donor kidney transplantation to African Americans with ESRD is a very critical issue because of the high demand for allografts in this population, which likely results from higher risk for ESRD, shorter renal allograft survival, and the presence of more barriers to cadaveric renal transplantation. Despite this increased need, black candidates for kidney transplantation are less likely to identify a living donor. Studies that examine the safety of live kidney donation from African Americans are greatly needed. Accurate estimates of long-term risk will help recipients, donors, and transplant teams as they weigh the risk of donation from individual candidates. If acceptable risk is demonstrated, then dissemination of these findings could greatly increase the willingness of African Americans to donate. If such studies indicate that the risk is excessive in certain such individuals, then prevention of donation and/or providing appropriate monitoring and interventions may limit or eliminate the future health problems that may have resulted from donation. We propose this study to take a 'first look' at this group of donors. Our hypothesis is that kidney donation from AALKD's increases the individual's risk of adverse renal sequelae. We will recruit the 197 AALKD's who donated between 3/96 and 3/02 to undergo health questionnaire and measurement of BP, serum creatinine, and urinary albumin excretion rate. The primary objective is to determine the risk of a combined endpoint of reduced estimated GFR (60 ml/min) or albuminuria in this cross section of AALKD's with at least 3 years of follow up, as compared to that observed in African Americans included in the NHANES III database.
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