Association of long-term low estimated glomerular filtration rate after living kidney donation with cardiovascular disease and mortality.

In the general population, eGFR <60 ml/min/1.73m2 is associated with increased risks of hypertension, cardiovascular disease (CVD), and mortality, and the risk increases as eGFR further decreases. We studied whether late postdonation (>1 year) low eGFR was associated with similar risks. The association of postdonation time-updated eGFR on time to hypertension, CVD, and mortality was assessed using sequential stratification proportional hazard models adjusting for clinical and demographic characteristics. Of 3,375 living kidney donors (LDs), 1775 (52.5%) developed eGFR<60 ml/min1.73m2 at a mean (SD) age of 57.6 (11.8) years and at 13.6 (11.9) years postdonation; 551 (16.3%) developed eGFR<45 ml/min/1.73m2 at a mean age of 65.0 (12.4) and at 19.1 (11.9) years postdonation. For LDs who reached a postdonation eGFR below 45ml/min/1.73m2, additional decrease of eGFR was associated with an increasing risk of CVD (aHR = 1.34, 95% CI 1.02-1.75 per 10 ml/min/1.73m2 lower eGFR) and mortality (aHR = 1.47, 95% CI:1.23-1.77 10 ml/min/1.73m2 lower eGFR). There was no association with development of hypertension. Our findings suggest that the eGFR threshold at which CVD and mortality risk increases is lower in LDs (<45 ml/min/1.73m2) compared with CKD due to chronic disease (<60 ml/min/1.73m2). These data inform the long-term follow-up of LDs.