Kidney-failure risk projection for the living kidney-donor candidate

Morgan E. Grams, Yingying Sang, Andrew S. Levey, Kunihiro Matsushita, Shoshana Ballew, Alex R. Chang, Eric K.H. Chow, Bertram L. Kasiske, Csaba Kovesdy, Girish N. Nadkarni, Varda Shalev, Dorry L. Segev, Josef Coresh, Krista L. Lentine, Amit X. Garg

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

BACKGROUND Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney. METHODS We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States. RESULTS A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation. CONCLUSIONS Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors.

Original languageEnglish (US)
Pages (from-to)411-421
Number of pages11
JournalNew England Journal of Medicine
Volume374
Issue number5
DOIs
StatePublished - Feb 4 2016

Fingerprint

Living Donors
Renal Insufficiency
Kidney
Chronic Kidney Failure
Health
Tissue Donors
Demography
Donor Selection
Albuminuria
Incidence
Glomerular Filtration Rate
Population
Meta-Analysis
Age Groups
Obesity
Smoking
Hypertension
Mortality

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Grams, M. E., Sang, Y., Levey, A. S., Matsushita, K., Ballew, S., Chang, A. R., ... Garg, A. X. (2016). Kidney-failure risk projection for the living kidney-donor candidate. New England Journal of Medicine, 374(5), 411-421. https://doi.org/10.1056/NEJMoa1510491

Kidney-failure risk projection for the living kidney-donor candidate. / Grams, Morgan E.; Sang, Yingying; Levey, Andrew S.; Matsushita, Kunihiro; Ballew, Shoshana; Chang, Alex R.; Chow, Eric K.H.; Kasiske, Bertram L.; Kovesdy, Csaba; Nadkarni, Girish N.; Shalev, Varda; Segev, Dorry L.; Coresh, Josef; Lentine, Krista L.; Garg, Amit X.

In: New England Journal of Medicine, Vol. 374, No. 5, 04.02.2016, p. 411-421.

Research output: Contribution to journalArticle

Grams, ME, Sang, Y, Levey, AS, Matsushita, K, Ballew, S, Chang, AR, Chow, EKH, Kasiske, BL, Kovesdy, C, Nadkarni, GN, Shalev, V, Segev, DL, Coresh, J, Lentine, KL & Garg, AX 2016, 'Kidney-failure risk projection for the living kidney-donor candidate', New England Journal of Medicine, vol. 374, no. 5, pp. 411-421. https://doi.org/10.1056/NEJMoa1510491
Grams ME, Sang Y, Levey AS, Matsushita K, Ballew S, Chang AR et al. Kidney-failure risk projection for the living kidney-donor candidate. New England Journal of Medicine. 2016 Feb 4;374(5):411-421. https://doi.org/10.1056/NEJMoa1510491
Grams, Morgan E. ; Sang, Yingying ; Levey, Andrew S. ; Matsushita, Kunihiro ; Ballew, Shoshana ; Chang, Alex R. ; Chow, Eric K.H. ; Kasiske, Bertram L. ; Kovesdy, Csaba ; Nadkarni, Girish N. ; Shalev, Varda ; Segev, Dorry L. ; Coresh, Josef ; Lentine, Krista L. ; Garg, Amit X. / Kidney-failure risk projection for the living kidney-donor candidate. In: New England Journal of Medicine. 2016 ; Vol. 374, No. 5. pp. 411-421.
@article{71b7cf7b99d742edb6cfc2a1948d4058,
title = "Kidney-failure risk projection for the living kidney-donor candidate",
abstract = "BACKGROUND Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney. METHODS We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States. RESULTS A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24{\%} among black men, 0.15{\%} among black women, 0.06{\%} among white men, and 0.04{\%} among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation. CONCLUSIONS Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors.",
author = "Grams, {Morgan E.} and Yingying Sang and Levey, {Andrew S.} and Kunihiro Matsushita and Shoshana Ballew and Chang, {Alex R.} and Chow, {Eric K.H.} and Kasiske, {Bertram L.} and Csaba Kovesdy and Nadkarni, {Girish N.} and Varda Shalev and Segev, {Dorry L.} and Josef Coresh and Lentine, {Krista L.} and Garg, {Amit X.}",
year = "2016",
month = "2",
day = "4",
doi = "10.1056/NEJMoa1510491",
language = "English (US)",
volume = "374",
pages = "411--421",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "5",

}

TY - JOUR

T1 - Kidney-failure risk projection for the living kidney-donor candidate

AU - Grams, Morgan E.

AU - Sang, Yingying

AU - Levey, Andrew S.

AU - Matsushita, Kunihiro

AU - Ballew, Shoshana

AU - Chang, Alex R.

AU - Chow, Eric K.H.

AU - Kasiske, Bertram L.

AU - Kovesdy, Csaba

AU - Nadkarni, Girish N.

AU - Shalev, Varda

AU - Segev, Dorry L.

AU - Coresh, Josef

AU - Lentine, Krista L.

AU - Garg, Amit X.

PY - 2016/2/4

Y1 - 2016/2/4

N2 - BACKGROUND Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney. METHODS We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States. RESULTS A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation. CONCLUSIONS Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors.

AB - BACKGROUND Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney. METHODS We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States. RESULTS A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation. CONCLUSIONS Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors.

UR - http://www.scopus.com/inward/record.url?scp=84956881529&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84956881529&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa1510491

DO - 10.1056/NEJMoa1510491

M3 - Article

VL - 374

SP - 411

EP - 421

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 5

ER -