Cardiovascular and Kidney Outcomes of Living Kidney Donors With Preexisting Hypertension: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
BACKGROUND: As the demand for living donor kidney transplantation increases, transplant programs have increasingly accepted hypertensive kidney donors. However, the safety of this practice remains unclear. This systematic review and meta-analysis aims to evaluate cardiovascular and kidney outcomes in living kidney donors with and without preexisting hypertension. METHODS: We performed a systematic search across MEDLINE, EMBASE, Cochrane CENTRAL, and EBM databases up to 1 October 2024. The exposure group consisted of living kidney donors with hypertension, while the comparator group included those without hypertension. Primary outcomes included differences in survival, major adverse cardiovascular events (MACE), estimated glomerular filtration rate (eGFR) of 45 mL/min/1.73 m² or less, and development of kidney failure, defined as requiring dialysis or a transplant. Risk differences (proportion of participants experiencing the outcome in the hypertensive group minus the proportion in the normotensive group, risk difference) for mortality, MACE, kidney failure, and eGFR ≤ 45 mL/min/1.73 m² were pooled for synthesis. RESULTS: Of the 983 studies screened, 17 were included, totaling 4,881 hypertensive and 40,565 normotensive kidney donors. The mean (SD) age at donation was 48.9 (18.1) years, with a median (IQR) follow-up of 5.0 (2.0-7.1) years. Hypertensive donors showed a significantly higher risk of death (RD 40.0 per 1,000 person years, 95% confidence interval (CI) 4.0, 70.0; P = 0.03), but no significant differences in kidney failure (RD 1.0 per 1,000 person years, 95% CI (0.3, 2.6); P = 0.13), eGFR ≤ 45 mL/min/1.73 m² (RD 20.0 per 1,000 person years, 95% CI, -90.0, 140.0; P = 0.69), or MACE (RD 3.0 per 1,000 person years, 95% CI, -90.0, 160.0; P = 0.58). CONCLUSIONS: This review suggests that hypertensive living kidney donors have a higher risk of death compared to normotensive donors, but no increased risk for kidney failure, low eGFR, or MACE. However, further long-term studies are needed, particularly for younger hypertensive donors.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.031 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".