2249-P: Long-Term Cardio-Kidney-Metabolic (CKM) Outcomes in Living Kidney Donors with Prediabetes

Introduction and Objective: Individuals with prediabetes are increasingly accepted as kidney donors, yet their long-term risks remain unclear. This study compared 10-year cardiometabolic outcomes among donors with prediabetes (Cohort 1), donors without prediabetes (Cohort 2), and non-donors with prediabetes (Cohort 3). Methods: TriNetX U.S. Collaborative Network analyzed outcomes from the time of index event (kidney donation for cohort 1 and 2, prediabetes for cohort 3) between June 2005 and June 2015. Each pair of cohorts were analyzed using Kaplan-Meier curves and Cox proportional hazards models after 1:1 propensity score matching (PSM). Results: TriNetX queries identified 989 patients in Cohort 1, 16,430 patients in Cohort 2, and 2,362,048 in Cohort 3 in the US. PSM resulted in 977 patients per cohort. 10-year survival analyses indicated no significant differences in cardiometabolic outcomes between Cohort 1 and Cohort 2. Compared with Cohort 3, Cohort 1 demonstrated significantly lower risk of diabetes (HR, 0.28; 95% CI, 0.22-0.35), hypertension (HR, 0.61; 95% CI=0.53-0.71), hyperlipidemia (HR, 0.71; 95% CI, 0.61-0.83), but higher risk of CKD (HR, 3.02; 95% CI, 2.38-3.84) and proteinuria (HR, 1.92; 95% CI, 1.30-2.82). When compared to Cohort 3, Cohort 2 showed lower risk of diabetes (HR, 0.26; 95% CI, 0.24-0.27), hypertension (HR, 0.33; 95% CI, 0.32-0.35), hyperlipidemia (HR, 0.34; 95% CI, 0.33-0.36), heart failure (HR, 0.32; 95% CI, 0.29-0.35), acute myocardial infarction (HR, 0.32; 95% CI, 0.27-0.37), stroke (HR, 0.24, 95% CI, 0.20-0.28) but elevated risk of proteinuria (HR, 1.25; 95% CI=1.12-1.40) and CKD (HR, 1.44; 95% CI, 1.37-1.53). Conclusion: No significant differences were seen in 10-year CKM outcomes among kidney donors with or without prediabetes. Surprisingly, kidney donors with prediabetes had lower risk of CKM outcomes than non-donors. Increased risk of proteinuria and CKD in donors independent of prediabetes implicate the role of single kidney. Disclosure I. Jami: None. F. Fang: None. M.S. Shah: None. Funding Junior Clinical Investigator Program funded by Sentara Health and the Macon and Joan Brock Virginia Health Sciences at Old Dominion University