Re: Cardiovascular disease in kidney donors: matched cohort study
We are grateful to Garg AX et al for their study informing the discussion on long-term repercussions of donor nephrectomy (1). We are reassured that their population did not evidence increased risk when compared to matched non-donors in the general population. The recent meta-analysis described in the discussion (2) correlates increased cardiovascular risk with lower GFR in the general population. It is unclear whether the same applies to the donor population; low GFR due to chronic kidney disease compared with low GFR due to donor nephrectomy may well lead to different health outcomes. Hence, it is still an open question as to whether cardiovascular risk stratification by GFR remains true for people with a solitary kidney.
To our disappointment, the authors did not have access to donor GFR and were not able to report these data in the study. We believe that there is a medical, if not ethical, duty to ensure monitoring of GFR post-donation (as well as proteinuria and blood pressure) is standard practice and that these data are accessible for ongoing audit of living kidney donation practices. Garg et al note that transplant centres use different acceptance criteria for living donors. As the pressure for organs increases, these criteria may be expanded. It is crucial that we do not compromise donor health in our desire to improve recipient outcomes. We look forward to the establishment of large living donor registries (3, 4) and further studies to aid our understanding of donor renal and non-renal outcomes in the future.
1. Garg, AX et al. Cardiovascular disease in kidney donors: matched cohort study. BMJ 2012; 344: e1203
2. Matsushita K et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375:2073-81.
3. ANZDATA LKDR, www.anzdata.org.au
4. Hartmann A et al. The risk of living kidney donation. Nephrol Dial Transplant 2003; 18: 871-873
Competing interests: No competing interests