Blood Pressure

Does Hypertension Affect Kidney Donation in the Long Term?

Hypertension may be a risk factor for end-stage kidney disease (ESKD) among older kidney donors, new research has shown. However, the risk for mortality is similar between older donors with vs without hypertension, according to the researchers.1

To evaluate the 15-year risk for ESKD and mortality, the researchers analyzed data on 24,533 kidney donors aged 50 years or older who either had or did not have hypertension from 1999 to 2016. In all, 2265 participants had predonation hypertension.


5 Questions About the Results of INFINITY

Quiz: The History of Hypertension

To determine ESKD development and mortality among the participants, the researchers linked this data to data from the Centers for Medicare and Medicaid Services and the Social Security Death Master File.

There was no documentation of antihypertensive therapy from 1999 to 2003, and so hypertension was defined as predonation systolic blood pressure (BP) of at least 140 or diastolic BP of at least 90 mm Hg. From 2004 to 2016, hypertension was defined as documented predonation use of antihypertensive therapy, regardless of systolic or diastolic BP.

The median follow-up was 7.1 years. During the study period, 24 cases of ESKD and 252 mortality events were reported.

Among donors with hypertension, the 15-year ESKD risk was 0.8%. Among donors without hypertension, the 15-year ESKD risk was 0.2%.

When the researchers assessed the data from only the years that predonation antihypertensive therapy was available, the association between hypertension and ESKD was stronger, with the risk for ESKD being 6.21-fold higher among donors using antihypertensive therapy compared with participants not using antihypertensive therapy.

There was also no significant association between donor hypertension and 15-year mortality.

“Fortunately, the number of kidney failure events in this population is small. Albeit a rather small risk, practice guidelines for live kidney donor evaluation need to be revisited,” said study co-author Fawaz Al Ammary, MD, PhD, from Johns Hopkins University School of Medicine, in a press release. “While controlled hypertension in otherwise eligible older individuals may not be viewed as an absolute contraindication for kidney donation, these findings may inform conversations between the provider and the older individuals with hypertension when they consider donating a kidney.”2

—Colleen Murphy


1. Al Ammary F, Luo X, Muzaale AD, et al. Risk of ESKD in older live kidney donors with hypertension [published online June 25, 2019]. Clin J Am Soc Nephrol.

2. Does hypertension pose a health risk to older adults who wish to donate a kidney? [press release]. Washington, D.C.: American Society of Nephrology; June 25, 2019. Accessed June 25, 2019.