Abstract
BACKGROUND: Limited data are available regarding clinical implications of lower renal function after living kidney donation. We examined a novel integrated database to study associations between postdonation estimated glomerular filtration rate (eGFR) and use of antihypertensive medication (AHM) treatment after living kidney donation. METHODS: Study data were assembled by linking national U.S. transplant registry identifiers, serum creatinine (SCr) values from electronic medical records, and pharmacy fill records for 3222 living donors (1989-2016) without predonation hypertension. Estimated GFR (mL/min per 1.73 m(2)) was computed from SCr values by the CKD-EPI equation. Repeated measures multivariable mixed effects modeling examined the associations (adjusted odds ratio, (95%LCL)aOR(95% UCL)) between AHM use and postdonation eGFR levels (random effect) with fixed effects for baseline donor factors. RESULTS: The linked database identified an average of 3 postdonation SCr values per donor (range: 1-38). Lower postdonation eGFR (vs ≥75) bore graded associations with higher odds of AHM use (eGFR 30-44: aOR (0.95)1.47(2.26); <30: aOR (1.08)2.52(5.90)). Other independent correlates of postdonation AHM use included older age at donation (aOR per decade: (1.08)1.23(1.40)), black race (aOR (1.03)1.51(2.21)), body mass index > 30 kg/m(2) (aOR (1.01)1.45(2.09)), first-degree donor-recipient relationship (aOR (1.07)1.38(1.79)), "prehypertension" at donation (systolic blood pressure 120-139: aOR (1.10)1.46(1.94); diastolic blood pressure 80-89: aOR (1.06)1.45(1.99)). CONCLUSIONS: This novel linkage illustrates the ability to identify postdonation kidney function and associate it with clinically meaningful outcomes; lower eGFR after living kidney donation is a correlate of AHM treatment requirements. Further work should define relationships of postdonation renal function, hypertension, and other morbidity measures.