Renal failure after live kidney donation

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Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Live kidney donation is common, but deprives the donor of about half of their renal function. The amount of renal function (glomerular filtration) is not standardized across the globe. A large US data base demonstrated that while the risk of a donor requiring renal support/dialysis was very low, it was higher than a matched cohort. ESRD was observed to occur years after the donation event. The estimated risk of ESRD after 15 years for the healthy population was 3.9/10,000 and ESRD risk estimated at 30.8/10,000 for kidney donors (p<0.001). Blacks were at higher risk of ESRD than non-black donors. While the risk of ESRD is small in those chosen as donors, there is an increased risk that potential donors should consider.
Time to detection: 
The mean time to detection in this study was 7.6 years. Live kidney donors should undergo maintenance healthcare surveillance to assess renal function.
Alerting signals, symptoms, evidence of occurrence: 
Typically very subtle until onset of ESRD.
Demonstration of imputability or root cause: 
Removing half an individual's renal function will accelerate their risk for ESRD.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
live kidney donation, risk of renal failure
Reference attachment: 
Suggest references: 
Risk of end-stage renal disease following live kidney donation. JAMA. 2014;311(6):579-586. doi:10.1001/jama.2013.285141
Expert comments for publication: 
While the US has different risk factors for progression of renal deterioration than other parts of the world, the report by Muzaale et al is illustrative of the low but real risk for development of renal failure in live kidney donors. What is not addressed are criteria for exclusion for donation: what risk is too great for an individual and how little GFR is insufficient to benefit the recipient.