Diabetes-free survival among living kidney donors and non-donors with obesity: A longitudinal cohort study

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.

[1]  C. Lewis,et al.  Change in Body Mass Index and Attributable Risk of New-Onset Hypertension Among Obese Living Kidney Donors , 2022, Annals of surgery.

[2]  A. Matas,et al.  Intermediate Renal Outcomes, Kidney Failure, and Mortality in Obese Kidney Donors , 2021, Journal of the American Society of Nephrology : JASN.

[3]  Burhaneddin Sandıkçı,et al.  Insulin Sensitivity After Living Donor Nephrectomy. , 2021, Transplantation proceedings.

[4]  Victor Zhong,et al.  Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018. , 2021, JAMA.

[5]  A. Matas,et al.  Outcomes of Kidney Donors With Impaired Fasting Glucose , 2021, Transplantation.

[6]  Amrita Saha,et al.  The Tangible Benefits of Living Donation: Results of a Qualitative Study of Living Kidney Donors , 2020, Transplantation direct.

[7]  K. Lentine,et al.  The Advancing American Kidney Health (AAKH) Executive Order: Promise and Caveats for Expanding Access to Kidney Transplantation. , 2020, Kidney360.

[8]  M. Blüher.  Metabolically Healthy Obesity , 2020, Endocrine reviews.

[9]  A. Garg,et al.  Associations of obesity with antidiabetic medication use after living kidney donation: An analysis of linked national registry and pharmacy fill records , 2019, Clinical transplantation.

[10]  J. Friedewald,et al.  Self-Reported Incident Hypertension and Long-Term Kidney Function in Living Kidney Donors Compared with Healthy Nondonors. , 2019, Clinical journal of the American Society of Nephrology : CJASN.

[11]  H. Morgenstern,et al.  Projecting ESRD Incidence and Prevalence in the United States through 2030. , 2018, Journal of the American Society of Nephrology : JASN.

[12]  A. Matas,et al.  Implications of excess weight on kidney donation: Long‐term consequences of donor nephrectomy in obese donors , 2018, Surgery.

[13]  P. Gordon-Larsen,et al.  Epidemiology of Obesity in Adults: Latest Trends , 2018, Current Obesity Reports.

[14]  A. Matas,et al.  Weight gain after kidney donation: Association with increased risks of type 2 diabetes and hypertension , 2018, Clinical transplantation.

[15]  S. Tullius,et al.  Improving the Supply and Quality of Deceased‐Donor Organs for Transplantation , 2018, The New England journal of medicine.

[16]  Bertram L Kasiske,et al.  An economic assessment of contemporary kidney transplant practice , 2018, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[17]  B. Kasiske,et al.  Temporal trends, center‐level variation, and the impact of prevalent state obesity rates on acceptance of obese living kidney donors , 2018, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[18]  Tanjala S. Purnell,et al.  The National Landscape of Living Kidney Donor Follow‐Up in the United States , 2017, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[19]  R. Foley,et al.  Renal Consequences of Diabetes After Kidney Donation , 2017, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[20]  A. Garg,et al.  Summary of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors , 2017, Transplantation.

[21]  C. Lewis,et al.  Obesity increases the risk of end-stage renal disease among living kidney donors. , 2017, Kidney international.

[22]  C. Lewis,et al.  Apolipoprotein L1 and Chronic Kidney Disease Risk in Young Potential Living Kidney Donors , 2017, Annals of surgery.

[23]  S. Tanamas,et al.  Estimating the risk of type-2 diabetes using obese-years in a contemporary population of the Framingham Study , 2016, Global health action.

[24]  M. Stegall,et al.  Survival Benefit with Kidney Transplants from HLA-Incompatible Live Donors. , 2016, The New England journal of medicine.

[25]  R. Foley,et al.  Renal Function Profile in White Kidney Donors: The First 4 Decades. , 2016, Journal of the American Society of Nephrology : JASN.

[26]  S. Fishbane,et al.  Weight trends in United States living kidney donors: Analysis of the UNOS database. , 2015, World journal of transplantation.

[27]  R. D'Agostino,et al.  Duration and Degree of Weight Gain and Incident Diabetes in Younger Versus Middle-Aged Black and White Adults: ARIC, CARDIA, and the Framingham Heart Study , 2015, Diabetes Care.

[28]  A. Garg,et al.  Medical Outcomes in African American Live Kidney Donors: A Matched Cohort Study , 2013, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[29]  C. Triplitt.  Understanding the kidneys' role in blood glucose regulation. , 2012, The American journal of managed care.

[30]  D. Asch,et al.  Short-Term Outcomes for Obese Live Kidney Donors and Their Recipients , 2009, Transplantation.

[31]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[32]  A. Kesselheim,et al.  Creating a medical, ethical, and legal framework for complex living kidney donors. , 2006, Clinical journal of the American Society of Nephrology : CJASN.

[33]  Rosalind Wright,et al.  Analysis of clustered and interval censored data from a community‐based study in asthma , 2004, Statistics in medicine.

[34]  L. Glimcher,et al.  Endoplasmic Reticulum Stress Links Obesity, Insulin Action, and Type 2 Diabetes , 2004, Science.

[35]  H. Pijl,et al.  Physiological hyperinsulinemia impairs insulin-stimulated glycogen synthase activity and glycogen synthesis. , 2001, American journal of physiology. Endocrinology and metabolism.

[36]  R. Wolfe,et al.  Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. , 1999, The New England journal of medicine.

[37]  Jon A. Wellner,et al.  A Hybrid Algorithm for Computation of the Nonparametric Maximum Likelihood Estimator from Censored Data , 1997 .

[38]  R. N. Bergman,et al.  Role of glucose and insulin resistance in development of type 2 diabetes mellitus: results of a 25-year follow-up study , 1992, The Lancet.

[39]  A. Folsom,et al.  The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. , 1989, American journal of epidemiology.

[40]  W. Duckworth,et al.  The renal metabolism of insulin , 1984, Diabetologia.

[41]  V. Trischitta,et al.  Role of insulin resistance in kidney dysfunction: insights into the mechanism and epidemiological evidence. , 2013, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[42]  R. Krauss,et al.  Diagnosis and management of the metabolic syndrome , 2005 .

[43]  S B Hulley,et al.  CARDIA: study design, recruitment, and some characteristics of the examined subjects. , 1988, Journal of clinical epidemiology.