Evaluation of Hypertension in Living Donor Candidates

Hypertension is a contributing cause of chronic kidney disease and cardiovascular morbidity and mortality. Careful assessment of blood pressure is warranted in all living kidney donor candidates via multiple office blood pressure readings and ideally also by ambulatory blood pressure monitoring. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline lowered the blood pressure threshold used to define hypertension; however, the applicability of this guideline to donor acceptance remains unclear. Risk of end-stage kidney disease (ESKD) in donors is impacted by age, race, gender, blood pressure, renal function, and body mass index (BMI) at the time of donation and family history of ESKD. Therefore, thresholds for acceptable blood pressure readings vary based on each donor candidate’s specific risk profile. Young donors, especially African American males and obese individuals, merit a higher level of scrutiny due to their longer anticipated life span and/or their higher risk for kidney failure. Conversely, older non-black individuals with well-controlled hypertension using a single antihypertensive agent, who have preserved kidney function and no evidence of target organ damage, may be acceptable donor candidates. Blood pressure has been reported to increase after live kidney donation although this may be partly due to greater scrutiny and is expected with increasing age. All donors should be encouraged to participate in postdonation follow-up for blood pressure management and adopt healthy lifestyle habits.