Eldaba Mariam, Ahmed Sumaiya, Hiremath Swapnil, Shorr Risa, Clark Edward G, Burns Kevin D, Knoll Greg, Bugeja Ann
Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
Department of Medicine, Division of Nephrology, The Ottawa Hospital, University of Ottawa, Kidney Research Centre, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Am J Hypertens. 2025 Jun 26. doi: 10.1093/ajh/hpaf114.
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 pre-existing hypertension.
We performed a systematic search across MEDLINE, EMBASE, Cochrane CENTRAL, and EBM databases up to October 1, 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/1.73m² 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, RD) for mortality, MACE, kidney failure, and eGFR ≤ 45 mL/min/1.73m² were pooled for synthesis.
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 1000 person years , 95% CI 4.0, 70.0 ; p=0.03), but no significant differences in kidney failure (RD 1.0 per 1000 person years , 95% CI (0.3, 2.6); p=0.13), eGFR ≤ 45 mL/min/1.73m² (RD 20.0 per 1000 person years, 95% CI -90.0, 140.0; p=0.69), or MACE (RD 3.0 per 1000 person years, 95% CI -90.0, 160.0; p=0.58).
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.
随着对活体供肾移植需求的增加，移植项目越来越多地接受高血压患者作为肾脏供体。然而，这种做法的安全性仍不明确。本系统评价和荟萃分析旨在评估有或无高血压病史的活体肾脏供体的心血管和肾脏结局。
我们在截至2024年10月1日的MEDLINE、EMBASE、Cochrane CENTRAL和EBM数据库中进行了系统检索。暴露组为患有高血压的活体肾脏供体，而对照组包括无高血压的供体。主要结局包括生存率差异、主要不良心血管事件（MACE）、估计肾小球滤过率（eGFR）低于45 mL/min/1.73m²，以及肾衰竭的发生，定义为需要透析或移植。汇总死亡率、MACE、肾衰竭和eGFR≤45 mL/min/1.73m²的风险差异（高血压组发生结局的参与者比例减去正常血压组的比例，RD）进行综合分析。
在筛选的983项研究中，纳入了17项，共有4881名高血压肾脏供体和40565名正常血压肾脏供体。捐赠时的平均（标准差）年龄为48.9（18.1）岁，中位（IQR）随访时间为5.0（2.0 - 7.1）年。高血压供体的死亡风险显著更高（RD为每1000人年40.0，95%CI为4.0，70.0；p = 0.03），但在肾衰竭（RD为每1000人年1.0，95%CI为（0.3，2.6）；p = 0.13）、eGFR≤45 mL/min/1.73m²（RD为每1000人年20.0，95%CI为 - 90.0，140.0；p = 0.69）或MACE（RD为每1000人年3.0，95%CI为 - 90.0，160.0；p = 0.58）方面无显著差异。
本综述表明，与正常血压供体相比，高血压活体肾脏供体的死亡风险更高，但肾衰竭、低eGFR或MACE的风险并未增加。然而，需要进一步开展长期研究，特别是针对年轻的高血压供体。
