Long-Term Clinical and Biochemical Outcomes in Living Kidney Donors at a Tertiary Care Center

Background: Donation nephrectomy leads to loss of renal mass and reduced glomerular filtration rate. Assessing long-term outcomes is crucial to ensure donor safety. Methods: We conducted a retrospective cohort study using the Electronic Medical Record from the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. We included 303 living kidney donors ≥18 years old who donated between 2000 and 2024. Donors were stratified by time since donation into three groups: <10 years (n=97), 10–20 years (n=121), and >20 years (n=85). Results: The mean age of our cohort was 53.9 ± 13.1 years, with an average BMI of 26.97 ± 4.57 kg/m2. Mean weight gain was4.13 ± 8.64 kg (6.41% ± 13.78%). Notably, 24.1% (n=73) of the donors had obesity (BMI ≥30 kg/m2). Current mean estimated Glomerular Filtration Rate (eGFR) was 76.84 ±16.86 ml/min/1.73 m2; mean urine albumin to creatinine ratio (uACR) was 21.85 ± 66.71 mg/g. uACR increased in donors with longer time since donation (p=0.0045). Prevalence of hypertension increased with time since donation (p < 0.001), reaching 34.1% in > 20 years post-donation. Type 2 diabetes and albuminuria showed a trend toward higher prevalence in the groups with longer time since donation (p = 0.092 and p = 0.0045, respectively). No significant differences were seen in dyslipidemia or cardiovascular events (stroke, acute myocardial infarction, or peripheral arterial disease) Conclusion: Living kidney donors are at risk for developing hypertension and albuminuria over time, even without major declines in eGFR. These findings highlight the importance of long-term follow-up in this population to detect and manage emerging risk factors for chronic kidney disease.