Remember those headlines not that long ago once again touting the ‘safety’ of living kidney donation to the living kidney donor, how we didn’t have to worry about dropping dead of cardiovascular disease and whatnot? Recall how annoyed I was over it?
Well – it appears I’m not the only one. A response was submitted to the journal which published said study, which can be read here (the letter begins on the bottom right of the second page).
(emphasis below is mine)
A meta-analysis from the same group reported a 5 mm Hg increase in systolic blood pressure in kidney donors about 10 years after nephrectomy.2 Taken together, these data suggest that blood pressure rises significantly after kidney donation but without an accompanying increase in cardiovascular morbidity or mortality. If this finding is confirmed, kidney donors would be the only group of patients yet studied in whom a rise in blood pressure has not been accompanied by an increase in mortality. In the general population, even a 2 mm Hg increase in systolic blood pressure confers a long term increase in mortality from stroke and cardiovascular disease of 10% and 7%, respectively. Thus, in kidney donors, either the data on blood pressure or on mortality are probably incorrect.
And my favorite:
The hidden danger is that, in our desire to improve outcomes in patients with established renal failure, we falsely reassure ourselves that the donor is not adversely affected.
From a second letter:
The authors have no access to data on donor GFR values so could not report them. We believe that there is a medical, if not ethical, duty to ensure monitoring of GFR (as well as proteinuria and blood pressure) after donation and that these data should be accessible for ongoing audit of living kidney donation practices.
We must not compromise donor health in our desire to improve outcomes in recipients.