Invite all donors to participate in follow-up studiesBMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2724 (Published 18 April 2012) Cite this as: BMJ 2012;344:e2724
- William E Moody, British Heart Foundation clinical research fellow and specialist registrar in cardiology1,
- Charles J Ferro, consultant nephrologist and honorary senior lecturer in nephrology2,
- Colin D Chue, cardiology research fellow and specialist registrar in cardiology1,
- Nicola C Edwards, clinical lecturer in cardiology and specialist registrar in cardiology1,
- Richard P Steeds, consultant cardiologist and honorary senior lecturer in cardiology3,
- Jonathan N Townend, consultant cardiologist and honorary reader in cardiology3
- 1Cardiovascular and Respiratory Sciences, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- 2Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- 3Department of Cardiology, Nuffield House, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Garg and colleagues provide new data that contribute greatly to our understanding of the long term consequences of living kidney donation.1 However, although they tried to match donors with non-donor controls, it is hard to determine whether the groups were truly comparable because information on blood pressure is lacking.
A meta-analysis from the same group reported a 5 mm Hg increase in systolic blood pressure in kidney donors about 10 years after nephrectomy.2 Taken together, these data suggest that blood pressure rises significantly after kidney donation but without an accompanying increase in cardiovascular morbidity or mortality.1 2 If this finding is confirmed, kidney donors would be the only group of patients yet studied in whom a rise in blood pressure has not been accompanied by an increase in mortality. In the general population, even a 2 mm Hg increase in systolic blood pressure confers a long term increase in mortality from stroke and cardiovascular disease of 10% and 7%, respectively.3 Thus, in kidney donors, either the data on blood pressure or on mortality are probably incorrect.
Nevertheless, even if blood pressure does increase it can be treated easily. The hidden danger is that, in our desire to improve outcomes in patients with established renal failure, we falsely reassure ourselves that the donor is not adversely affected. To safeguard the expanding practice of living kidney donation, we suggest inviting all donors to participate prospectively in pathophysiological and epidemiological studies.
Cite this as: BMJ 2012;344:e2724
Competing interests: None declared.