Racial Variation in Medical Outcomes among Living Kidney Donors — NEJM

Racial Variation in Medical Outcomes among Living Kidney Donors
Krista L. Lentine, M.D., Mark A. Schnitzler, Ph.D., Huiling Xiao, M.S., Georges Saab, M.D., Paolo R. Salvalaggio, M.D., Ph.D., David Axelrod, M.D., Connie L. Davis, M.D., Kevin C. Abbott, M.D., M.P.H. and Daniel C. Brennan, M.D.

N Engl J Med 2010; 363:724-732August 19, 2010

Data regarding health outcomes among living kidney donors are lacking, especially among nonwhite persons.

Methods
We linked identifiers from the Organ Procurement and Transplantation Network (OPTN) with administrative data of a private U.S. health insurer and performed a retrospective study of 4650 persons who had been living kidney donors from October 1987 through July 2007 and who had post-donation nephrectomy benefits with this insurer at some point from 2000 through 2007. We ascertained post-nephrectomy medical diagnoses and conditions requiring medical treatment from billing claims. Cox regression analyses with left and right censoring to account for observed periods of insurance benefits were used to estimate absolute prevalence and prevalence ratios for diagnoses after nephrectomy. We then compared prevalence patterns with those in the 2005–2006 National Health and Nutrition Examination Survey (NHANES) for the general population.



Results
Among the donors, 76.3% were white, 13.1% black, 8.2% Hispanic, and 2.4% another race or ethnic group. The median time from donation to the end of insurance benefits was 7.7 years. After kidney donation, black donors, as compared with white donors, had an increased risk of hypertension (adjusted hazard ratio, 1.52; 95% confidence interval [CI], 1.23 to 1.88), diabetes mellitus requiring drug therapy (adjusted hazard ratio, 2.31; 95% CI, 1.33 to 3.98), and chronic kidney disease (adjusted hazard ratio, 2.32; 95% CI, 1.48 to 3.62); findings were similar for Hispanic donors. The absolute prevalence of diabetes among all donors did not exceed that in the general population, but the prevalence of hypertension exceeded NHANES estimates in some subgroups. End-stage renal disease was identified in less than 1% of donors but was more common among black donors than among white donors.



Conclusions
As in the general U.S. population, racial disparities in medical conditions occur among living kidney donors. Increased attention to health outcomes among demographically diverse kidney donors is needed. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.)


Source Information
From the Center for Outcomes Research (K.L.L., M.A.S., H.X.) and the Division of Nephrology (K.L.L.), Saint Louis University School of Medicine; and the Division of Nephrology, Washington University School of Medicine (G.S., D.C.B.) — both in St. Louis; the Kidney and Pancreas Transplant Program, University of Washington, Seattle (P.R.S., C.L.D.); the Department of Surgery, Dartmouth–Hitchcock Medical Center, Hanover, NH (D.A.); and the Nephrology Service, Walter Reed Army Medical Center, Washington, DC (K.C.A.).

Address reprint requests to Dr. Lentine at Saint Louis University Center for Outcomes Research, Salus Center, 4th Fl., 3545 Lafayette Ave., St. Louis, MO 63104, or at lentinek@slu.edu.

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Racial Variation in Medical Outcomes among Living Kidney Donors — NEJM