Are there tools to predict ESKD risk for a living donor candidate?
Yes. Grams et al. used a meta-analysis of seven general non-donor populations and calibrated the population level incidence of ESKD and mortality. This was compared to 15-year projections with the observed risk among 52,998 living donors.
In a 40-year-old non-donor with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESKD varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Important risk factors influencing the development of ESKD over time included a lower estimated glomerular filtration rate at time of donation, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESKD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks of ESKD after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation.
The ESKD Risk Tool for Kidney Donor Candidates Calculator can be found at http://www. transplantmodels.com/