Get Well Wednesday: What You Need To Know About Kidney Disease

Dr. Jerry McCauley obtained his undergraduate and medical degree at Dartmouth and completed his MPH at the University of Pittsburgh. He has been a faculty member at Tufts University...

Dr. Jerry McCauley obtained his undergraduate and medical degree at Dartmouth and completed his MPH at the University of Pittsburgh. He has been a faculty member at Tufts University and the University of Pittsburgh.

Dr. McCauley rose through the ranks at the University of Pittsburgh where he became Director of Transplantation Nephrology, Medical Director of the Kidney/Pancreas and Islet Cell Transplantation Program, and Professor of Medicine and Surgery.  Since 2013 he has been the Chief of Nephrology at Thomas Jefferson University in Philadelphia.

WHAT YOU NEED TO KNOW ABOUT KIDNEY FAILURE

Why do African-Americans have a far greater risk of developing kidney failure than others?

African-Americans have three times more risk of developing kidney disease than whites. This is primarily due to high rates of diabetes and hypertension which are the leading causes of kidney failure for all Americans. They also have more frequent diseases like lupus which can cause kidney failure. Other diseases of the filtering units in the kidney (glomerulus) are more common and severe in African-Americans. Focal segmental glomerulosclerosis is the most common and severe form of these diseases.

How many African-Americans are waiting for kidney transplants?

There are approximately 100,000 people waiting for kidney transplants in the US and about 35% are African-Americans so that about 35, 000 African-Americans are waiting for kidney transplants.

How are donor kidneys allocated and are there enough available?

Deceased donor kidneys are allocated by a point system which is based on a set of donor and patient characteristics. Kidneys are not matched by race such that African-Americans are more likely to get a kidney from a White person than from an African-American.

Factors included in giving points included the time on dialysis, and others. The new allocation system effectively matches donor and recipient by age and other factors by a calculation termed the Kidney Donor Profile Index (KDPI) which estimates the risk of kidney failure compared to the average donor. Very low numbers (20% and less) typically goes to young people based upon another calculation termed the Estimated Post Transplant Survival (EPTS) which estimates patient survival after transplant.

Factors included in the EPTS are 1) Candidate time on dialysis, 2) Current diagnosis of diabetes, 3) Prior solid organ transplants, 4) Candidate age. Points are also given for prior organ donors and for patients who have a large number of antibodies against potential donors (sensitized patients).

These sensitized patients seldom were transplanted with the old system and now are transplanted rapidly. Kidneys from Public Health System (PHS) High Risk categories can be allocated to anyone regardless of age but the patient must declare that they are interested in this type of donor.

Typically these donors are opioid users and others at risk of hepatitis or HIV. They are screened for these diseases before transplantation and patients with HIV are not used except for a special study which is available in a limited number of centers. Hepatitis B or C positive donors may be offered to patients who are already positive for these viruses.

Are there enough donors?

No. In 2016 only about 19,000 kidneys were transplanted for a waitlist of about 100,000.

How can family and friends find out if they’re eligible?

For willing donors the only way to find out if you are a potential donor is to tell the patient that you are willing to donate. After this important step you should contact the transplant center to be certain if you qualify. You should not decide on your own. The center will be best in determining if you are healthy enough to donate or if any health problems would prohibit it.

The new allocation system gives points from the time a patient starts dialysis instead of when they complete all the tests needed to be listed. This has been a major aid in African-Americans getting on the list. Previous allocation systems did not use the KDPI or EPTS to allocate organs and tissue typing derived points have been li

mited to only one locus instead of three. Sensitized patients now get points from lower numbers starting with zero. The old system only gave points once the patients were 80% sensitized. As mentioned earlier, it approximately matches donors and recipients by age so that a 20-year-old donor kidney will not usually go to a 75-year-old recipient since that 20-year-old kidney is expected to give more years of functioning than the patient is expected to live. The PHS high risk kidneys can go to older patients and many of these transplants have been done with very low rates of disease transmission.

What is the average waitlist time?

Nationally, the average waitlist time is about 3 ½ years but this varies by geographic area and transplant center. In some centers the wait for a deceased donor may be a bit more than a year and in others it may be ten years. It is important for patients to inquire at the transplant center about their particular wait time. The best way to avoid waiting for a kidney transplant is to get a living donor kidney transplant.

Do kidney donors and recipients have to be the same race?

No. Race is not a factor in selecting or matching kidney transplants.

Is there a difference between a kidney from a living donor or a deceased donor?

Yes. Living donor kidney tend to function immediately after transplantation and last years longer. This is true whether the kidney comes from a relative or someone unrelated. When possible, patients should receive a living donor transplant. The waiting times for deceased donors do not apply to living donation in that the donor and recipient can schedule the transplant like any other elective medical treatment instead of waiting for some unknown period of time.

What if I donate a kidney and later need a kidney transplant?

In such cases the former donor is given a large number of points on the waiting list which allows them to be transplanted much quicker than the average patient. It is very important to avoid this situation. Donors are healthy at the time of donation and should practice measures to remain healthy.

Diabetes and hypertension are the leading causes of kidney failure nationally. These two diseases often develop when patients become obese. It is vital that donors (and non-donors) maintain healthy body weight. Weight gain can cause diabetes and hypertension. Donation will not cause these illnesses but will not protect you if you gain excessive weight

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