Risk of ESRD in prior living kidney donors

We studied End‐Stage Renal Disease ( ESRD ) in living kidney donors ( LKD s) who donated in the United States between 1994 and 2016 (n = 123 526), using Organ Procurement and Transplantation Network and Centers for Medicare and Medicaid Services data. Two hundred eighteen LKD s developed ESRD , with a median of 11.1 years between donation and ESRD . Absolute 20‐year risk was low but not uniform, with risk associated with race, age, and sex and increasing exponentially over time. LKD s had increased risk of ESRD if they were male (adjusted hazard ratio [ aHR ]: 1.75, 95% confidence interval [95% CI ]: 1.33‐2.31), had higher BMI ( aHR : 1.34 per 5 kg/m 2 , 95% CI : 1.10‐1.64) or lower estimated GFR ( aHR : 0.89 per 10 mL /min, 95% CI : 0.80‐0.99), were first‐degree relatives of the recipient (parent: [ aHR : 2.01, 95% CI : 1.26‐3.21]; full sibling [ aHR : 1.87, 95% CI : 1.23‐2.84]; identical twin [ aHR : 19.79, 95% CI : 7.65‐51.24]), or lived in lower socioeconomic status neighborhoods at donation ( aHR : 0.87 per $10k increase; 95% CI : 0.77‐0.99). We found a significant interaction between donation age and race, with higher risk at older ages for white LKD s ( aHR : 1.26 per decade, 95% CI : 1.04‐1.54), but higher risk at younger ages for black LKD s ( aHR : 0.75 per decade, 95% CI : 0.57‐0.99). These findings further inform risk assessment of potential LKDs.