Prevalence and risk factors of hypertension following nephrectomy in living kidney donors.

Living donor kidney transplantation is the treatment of choice for the patients with end-stage renal disease, especially where deceased donor programs are limited. There are limited data on the outcomes of living kidney donors (LKD) from developing countries, especially from North Africa. The aim of this study is to evaluate the prevalence of hypertension (HTN) in LKD and to analyze its risk factors. This is a longitudinal monocentric study, and the donors who underwent nephrectomy for donation between 2006 and 2015 were included. Ninety-two donors were assessed. The mean age at the time of nephrectomy was 42.8 ± 10 years (21-68 years). The sex ratio was 0.6. At the time of donation, the median systolic blood pressure was 120 mm Hg and the median diastolic blood pressure was 70 mm Hg. HTN was noted in 4% of donors. The median follow-up duration was 26 months. Two years after donation, the prevalence of HTN was 28% in the study group (8% male and 20% female). The mean time to development of HTN was 16 months. Associations between HTN after donation and the cardiovascular family history, age >40 years, HTN, obesity, android obesity, glomerular filtration rate GFR <90 mL/min/1.73 m2, perioperative HTN, and dyslipidemia were noted. The multivariate analysis showed that obesity at the time of donation was a risk factor for HTN (odds ratio = 4.8; P = 0.04). Obese donor [body mass index (BMI) ≥30)] has higher risk of HTN after nephrectomy than nonobese donor.

Short- and long-term follow-up of living kidney donors.

Living-donor kidney transplantation is a well-established treatment of end-stage renal disease in Tunisia. Over the years, concerns have increased about the harmlessness of kidney donation. This longitudinal single center study was carried out to evaluate the safety of nephrectomy as well as further medical and surgical outcomes among donors. We collected and analyzed clinical, biological, biochemical and kidney size data at the time of nephrectomy and at M1, M3, M6, Y1, Y2, and Y4 after donation measured by ultrasound. All donor nephrectomies performed in the nephrology and transplantation unit of Sahloul Hospital of Sousse since October 2006 were included. Criteria of exclusion were lost to follow-up or lack of complete data. Of the 106 donors (66 females and 40 males), 92 donors were included in the follow-up analysis after following exclusion criteria. The mean age at the time of nephrectomy was 42.8 ± 10 years with the sex ratio 0.6. and 27% of our donors were mothers. Twenty-two percent of the donors were obese and 4% were hypertensive. The median initial glomerular filtration rate (GFR) was 105 mL/min/1.73 m2. The surgical approach was costal lumbotomy in 96% of cases and laparoscopy for four cases. The kidneys were removed from the left side in 93% of cases. Postoperative mortality was zero and early postoperative morbidity was low. The median duration of hospital stay was nine days. During follow-up, 14% attended all recommended visits. The median follow-up duration was 26 months. After two years post donation, the prevalence of HTN was 28% and obesity was 26%. The prevalence of GFR decline (50-59 mL/min) was 14% using formula by modification of diet in renal disease. None of our donors reached stage 4 or 5 CKD. Twelve had proteinuria and one donor had diabetes, a comparable prevalence of morbidities to the general population.