Undiagnosed hypertension in potential kidney donors and case for comprehensive medical and psychosocial assessment

Aim: Among kidney donors, it is critical to identify risk factors that impact post-kidney donation outcomes. Undiagnosed hypertension (HTN) may impact future kidney health. Office blood pressure (OBP) measurement is not always reliable but 24-h ambulatory BP monitoring (ABPM) can help diagnose HTN and uncover white-coat HTN and masked HTN. We studied the utility of ABPM in identifying kidney donors not previously diagnosed with HTN. Methods: We conducted a retrospective review of 303 potential kidney donors from 1/1/2012 to 12/31/2017 who completed ABPM. Categorical variables were summarized with N (%) and continuous variables were summarized with median (range). Differences among groups were assessed using the Kruskal-Wallis rank sum test for continuous measures and the Pearson Chi-Square test for categorical measures. All tests were two-sided and performed at the 0.05 significance level. Results: Twenty-four (7.9%) subjects had prior diagnosis of HTN. Among 279 potential donor candidates without prior HTN, 70 (25.2%) were newly diagnosed with HTN with ABPM. OBP was elevated only in 9 out of 70 (12.9%) of newly diagnosed HTN subjects. Overall, 34 (12.9%) had masked hypertension and 14 (5.3%) had white coat hypertension. Comparison of group 1 (newly diagnosed HTN with ABP) with Group 2 (normal ABP) showed more males in group 1 (55.7% vs 34.5%, p = .001). Fewer donors were accepted to be donors in group 1 (34.8% vs 56.4% p = .002). Conclusion: 1 out of 4 potential kidney donors had undiagnosed HTN. Evaluators providing psychosocial assessments should take into account the nature of medical assessment completed when reviewing risk benefit ratio.