BACKGROUND: Chronic kidney disease increases the risk of bone fragility fractures (osteoporotic fractures). Living kidney donors lose 50% of their renal mass and show changes in calcium homeostasis. We studied whether living kidney donation increases the risk of fragility fracture. DESIGN: Retrospective matched-cohort study. SETTING & PARTICIPANTS: We reviewed the medical charts of all 2,015 adults in Ontario, Canada, who donated a kidney between 1992 and 2009 (surgeries performed across 5 transplant programs). We linked this information to health care databases and randomly selected 20,150 matched nondonors from the healthiest portion of the general population. Median age was 43 (95% CI, 24-50) years at study enrollment. Donors and nondonors were then followed up for a median of 6.6 years and a maximum of 17.7 years. PREDICTOR: Living donor nephrectomy. OUTCOMES: The primary outcome was lower- and upper-extremity fragility fractures. Individuals who reached 66 years or older in follow-up had bisphosphonate prescriptions recorded. RESULTS: The rate of fragility fracture was no higher in donors compared with nondonors (16.4 vs 18.7 events/10,000 person-years; rate ratio, 0.88; 95% CI, 0.58-1.32). Results were similar in multiple additional analyses. There was little difference in the proportion of older adults in follow-up who received a bisphosphonate prescription (17.1% vs 15.2%; P = 0.4). LIMITATIONS: These are interim results. Ongoing surveillance of this and other donor cohorts is warranted to be sure an association does not manifest with longer follow-up. CONCLUSIONS: To date, there is no evidence of increased fragility fracture risk in living kidney donors. Our results meet an information need and are reassuring for the safety of the practice.
BACKGROUND:Chronic kidney disease increases the risk of bone fragility fractures (osteoporotic fractures). Living kidney donors lose 50% of their renal mass and show changes in calcium homeostasis. We studied whether living kidney donation increases the risk of fragility fracture. DESIGN: Retrospective matched-cohort study. SETTING & PARTICIPANTS: We reviewed the medical charts of all 2,015 adults in Ontario, Canada, who donated a kidney between 1992 and 2009 (surgeries performed across 5 transplant programs). We linked this information to health care databases and randomly selected 20,150 matched nondonors from the healthiest portion of the general population. Median age was 43 (95% CI, 24-50) years at study enrollment. Donors and nondonors were then followed up for a median of 6.6 years and a maximum of 17.7 years. PREDICTOR: Living donor nephrectomy. OUTCOMES: The primary outcome was lower- and upper-extremity fragility fractures. Individuals who reached 66 years or older in follow-up had bisphosphonate prescriptions recorded. RESULTS: The rate of fragility fracture was no higher in donors compared with nondonors (16.4 vs 18.7 events/10,000 person-years; rate ratio, 0.88; 95% CI, 0.58-1.32). Results were similar in multiple additional analyses. There was little difference in the proportion of older adults in follow-up who received a bisphosphonate prescription (17.1% vs 15.2%; P = 0.4). LIMITATIONS: These are interim results. Ongoing surveillance of this and other donor cohorts is warranted to be sure an association does not manifest with longer follow-up. CONCLUSIONS: To date, there is no evidence of increased fragility fracture risk in living kidney donors. Our results meet an information need and are reassuring for the safety of the practice.
Authors: Amit X Garg; Immaculate F Nevis; Eric McArthur; Jessica M Sontrop; John J Koval; Ngan N Lam; Ainslie M Hildebrand; Peter P Reese; Leroy Storsley; John S Gill; Dorry L Segev; Steven Habbous; Ann Bugeja; Greg A Knoll; Christine Dipchand; Mauricio Monroy-Cuadros; Krista L Lentine Journal: N Engl J Med Date: 2014-11-14 Impact factor: 91.245
Authors: Jesse D Schold; David A Goldfarb; Laura D Buccini; James R Rodrigue; Didier Mandelbrot; Emily L G Heaphy; Richard A Fatica; Emilio D Poggio Journal: Clin J Am Soc Nephrol Date: 2014-01-23 Impact factor: 8.237
Authors: Jesse D Schold; David A Goldfarb; Laura D Buccini; James R Rodrigue; Didier A Mandelbrot; Emily L G Heaphy; Richard A Fatica; Emilio D Poggio Journal: Clin J Am Soc Nephrol Date: 2013-09-26 Impact factor: 8.237
Authors: Krista L Lentine; Ngan N Lam; Mark A Schnitzler; Amit X Garg; Huiling Xiao; Sheila E Leander; Daniel C Brennan; Sandra J Taler; David Axelrod; Dorry L Segev Journal: Clin Transplant Date: 2015-09-18 Impact factor: 2.863