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Reed RD, McLeod MC, MacLennan PA, Kumar V, Pittman SE, Maynor AG, Stanford LA, Baker GA, Schinstock CA, Silkensen JR, Roll GR, Segev DL, Orandi BJ, Lewis CE, Locke JE. Change in Body Mass Index and Attributable Risk of New-Onset Hypertension Among Obese Living Kidney Donors. Ann Surg 2023; 278:e115-e122. [PMID: 35946818 PMCID: PMC9911559 DOI: 10.1097/sla.0000000000005669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether body mass index (BMI) changes modify the association between kidney donation and incident hypertension. BACKGROUND Obesity increases hypertension risk in both general and living kidney donor (LKD) populations. Donation-attributable risk in the context of obesity, and whether weight change modifies that risk, is unknown. METHODS Nested case-control study among 1558 adult LKDs (1976-2020) with obesity (median follow-up: 3.6 years; interquartile range: 2.0-9.4) and 3783 adults with obesity in the Coronary Artery Risk Development in Young Adults (CARDIA) and Atherosclerosis Risk in Communities (ARIC) studies (9.2 y; interquartile range: 5.3-15.8). Hypertension incidence was compared by donor status using conditional logistic regression, with BMI change investigated for effect modification. RESULTS Overall, LKDs and nondonors had similar hypertension incidence [incidence rate ratio (IRR): 1.16, 95% confidence interval (95% CI): 0.94-1.43, P =0.16], even after adjusting for BMI change (IRR: 1.25, 95% CI: 0.99-1.58, P =0.05). Although LKDs and nondonors who lost >5% BMI had comparable hypertension incidence (IRR: 0.78, 95% CI: 0.46-1.34, P =0.36), there was a significant interaction between donor and >5% BMI gain (multiplicative interaction IRR: 1.62, 95% CI: 1.15-2.29, P =0.006; relative excess risk due to interaction: 0.90, 95% CI: 0.24-1.56, P =0.007), such that LKDs who gained weight had higher hypertension incidence than similar nondonors (IRR: 1.83, 95% CI: 1.32-2.53, P <0.001). CONCLUSIONS Overall, LKDs and nondonors with obesity had similar hypertension incidence. Weight stability and loss were associated with similar hypertension incidence by donor status. However, LKDs who gained >5% saw increased hypertension incidence versus similar nondonors, providing support for counseling potential LKDs with obesity on weight management postdonation.
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Affiliation(s)
- Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | | | - Paul A. MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Sydney E. Pittman
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Andrew G. Maynor
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Luke A. Stanford
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Gavin A. Baker
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | | | | | - Garrett R. Roll
- Division of Transplant, Department of Surgery, University of California San Francisco
| | | | - Babak J. Orandi
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Jayme E. Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham
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Killian AC, Reed RD, McLeod MC, MacLennan PA, Kumar V, Pittman SE, Maynor AG, Stanford LA, Baker GA, Schinstock CA, Silkensen JR, Roll GR, Segev DL, Orandi BJ, Lewis CE, Locke JE. Diabetes-free survival among living kidney donors and non-donors with obesity: A longitudinal cohort study. PLoS One 2022; 17:e0276882. [PMID: 36399462 PMCID: PMC9674148 DOI: 10.1371/journal.pone.0276882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/13/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Approval of living kidney donors (LKD) with end-stage kidney disease (ESKD) risk factors, such as obesity, has increased. While lifetime ESKD development data are lacking, the study of intermediate outcomes such as diabetes is critical for LKD safety. Donation-attributable diabetes risk among persons with obesity remains unknown. The purpose of this study was to evaluate 10-year diabetes-free survival among LKDs and non-donors with obesity. METHODS This longitudinal cohort study identified adult, LKDs (1976-2020) from 42 US transplant centers and non-donors from the Coronary Artery Risk Development in Young Adults (1985-1986) and the Atherosclerosis Risk in Communities (1987-1989) studies with body mass index ≥30 kg/m2. LKDs were matched to non-donors on baseline characteristics (age, sex, race, body mass index, systolic and diastolic blood pressure) plus diabetes-specific risk factors (family history of diabetes, impaired fasting glucose, smoking history). Accelerated failure time models were utilized to evaluate 10-year diabetes-free survival. FINDINGS Among 3464 participants, 1119 (32%) were LKDs and 2345 (68%) were non-donors. After matching on baseline characteristics plus diabetes-specific risk factors, 4% (7/165) LKDs and 9% (15/165) non-donors developed diabetes (median follow-up time 8.5 (IQR: 5.6-10.0) and 9.1 (IQR: 5.9-10.0) years, respectively). While not significant, LKDs were estimated to live diabetes-free 2 times longer than non-donors (estimate 1.91; 95% CI: 0.79-4.64, p = 0.15). CONCLUSIONS LKDs with obesity trended toward living longer diabetes-free than non-donors with obesity, suggesting within the decade following donation there was no increased diabetes risk among LKDs. Further work is needed to evaluate donation-attributable diabetes risk long-term.
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Affiliation(s)
- A. Cozette Killian
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - M. Chandler McLeod
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Paul A. MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Sydney E. Pittman
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Andrew G. Maynor
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Luke A. Stanford
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Gavin A. Baker
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Carrie A. Schinstock
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - John R. Silkensen
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, United States of America
| | - Garrett R. Roll
- Division of Transplant, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Babak J. Orandi
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jayme E. Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
- * E-mail:
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