Can you donate a kidney safely, with regard to your own long term kidney function? As more people are encouraged to consider so-called 'live donation,' most often to provide a kidney to a loved one who needs one, it is incumbent upon physicians to inform this decision with as much accuracy as can be mustered. Enter a study by Johns Hopkins investigator Morgan Grams and colleagues, published in NEJM this week, that Rick and I discuss on PodMed.
Researchers crunched data from a number of databases to look at overall risk of developing kidney disease during one's lifetime, then looked at the actual observed risk for kidney failure among living kidney donors. They calculated that a constellation of risk factors, including age, race, presence of existing kidney function compromise, diabetes, obesity and others, can be employed to predict an individual's risk of developing kidney failure after donating a kidney. The hope is that this calculator will enable clinicians to have frank discussions with their patients regarding risk. The other possibility illustrated by this paper is that of older individuals being considered as donors. As Rick so succinctly puts it in the podcast, chances are good if you haven't experienced kidney function compromise or failure by the time you're 65 you probably won't, and the calculator can help support that assertion. It's worth keeping in mind, of course, that no one's individual risk can be pinpointed with this or any method, since that outcome can only be known after donation has taken place.
Other topic this week include off label drug use in JAMA Internal Medicine, risk of malpractice claims relative to amount of testing a physician orders in BMJ, and in PNAS, an increased in mortality among middle aged Caucasians. Until next week, y'all live well.