Objective: 

To examine whether body mass index (BMI) changes modify the association between kidney donation and incident hypertension.

Summary Background Data: 

Obesity increases hypertension risk in both general and living kidney donor (LKD) populations. Donation-attributable risk in the context of obesity, and whether weight change modifies that risk, is unknown.

Methods: 

Nested case-control study among 1,558 adult LKDs (1976-2020) with obesity (median follow-up: 3.6 years (IQR: 2.0-9.4)) and 3,783 adults with obesity in the Coronary Artery Risk Development in Young Adults (CARDIA) and Atherosclerosis Risk in Communities (ARIC) studies (9.2 y (IQR: 5.3-15.8)). Hypertension incidence was compared by donor status using conditional logistic regression, with BMI change investigated for effect modification.

Results: 

Overall, LKDs and non-donors had similar hypertension incidence (incidence rate ratio (IRR): 1.16, 95%CI: 0.94-1.43, P=0.16), even after adjusting for BMI change (IRR: 1.25, 95%CI: 0.99-1.58, P=0.05). Although LKDs and non-donors who lost >5% BMI had comparable hypertension incidence (IRR: 0.78, 95%CI: 0.46-1.34, P=0.36), there was a significant interaction between donor and >5% BMI gain (multiplicative interaction IRR: 1.62, 95%CI: 1.15-2.29, P=0.006; relative excess risk due to interaction: 0.90, 95%CI: 0.24-1.56, P=0.007), such that LKDs who gained weight had higher hypertension incidence than similar non-donors (IRR: 1.83, 95%CI: 1.32-2.53, P<0.001).

Conclusions: 

Overall, LKDs and non-donors with obesity had similar hypertension incidence. Weight stability and loss were associated with similar hypertension incidence by donor status. However, LKDs who gained >5% saw increased hypertension incidence versus similar non-donors, providing support for counseling potential LKDs with obesity on weight management post-donation.

中文翻译：

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肥胖活体肾捐献者的体重指数变化和新发高血压的归因风险

客观的： 

研究体重指数 (BMI) 的变化是否会改变肾脏捐赠与高血压之间的关联。

摘要背景数据： 

肥胖会增加普通人群和活体肾捐献者 (LKD) 人群的高血压风险。肥胖背景下的捐赠归因风险以及体重变化是否会改变该风险尚不清楚。

方法： 

在 1,558 名患有肥胖症的成人 LKD（1976-2020 年）中进行的巢式病例对照研究（中位随访时间：3.6 年（IQR：2.0-9.4））和 3,783 名患有肥胖症的成人在年轻人冠状动脉风险发展 (CARDIA) 和社区动脉粥样硬化风险 (ARIC) 研究（9.2 年（IQR：5.3-15.8））。使用条件逻辑回归根据供体状况比较高血压发生率，并研究体重指数变化以进行效果修正。

结果： 

总体而言，LKD 和非捐赠者的高血压发病率相似（发病率比 (IRR)：1.16，95%CI：0.94-1.43，P =0.16），即使在调整 BMI 变化后（IRR：1.25，95%CI：0.99） -1.58，P =0.05）。尽管 LKD 和 BMI 下降 > 5% 的非捐赠者的高血压发病率相当（IRR：0.78，95% CI：0.46-1.34，P = 0.36），但捐赠者和 BMI 增加 > 5% 之间存在显着的交互作用（乘法交互作用） IRR: 1.62, 95%CI: 1.15-2.29, P =0.006; 交互作用导致的相对超额风险: 0.90, 95%CI: 0.24-1.56, P =0.007)，因此体重增加的 LKD 的高血压发病率高于类似的 LKD非捐赠者（IRR：1.83，95％CI：1.32-2.53，P <0.001）。

结论： 

总体而言，LKD 和肥胖的非捐赠者的高血压发病率相似。体重稳定和体重减轻与捐献者状态相似的高血压发病率相关。然而，与类似的非捐赠者相比，体重增加 >5% 的 LKD 的高血压发病率有所增加，这为潜在的肥胖 LKD 捐赠后体重管理方面的咨询提供了支持。