Optimising living kidney donor follow up

Aim: To audit the effectiveness of an intervention intended to increase rate of living kidney donor (LKD) follow-up. Background: Post-donation follow-up care is recommended by KDIGO for LKD. There is little long-term data of living kidney donors in Australia due to incomplete follow-up.

Methods: In 2012 we reported follow-up of LKD at 1 year of 70%, but less than 10% at 5 years. Statewide follow-up was changed to be coordinated out of a single follow-up centre, with tests and appointments organized by standard mail. We reviewed the effectiveness of this intervention.

Results: We identified 183 LKD, of which 126 (63% female, mean age 62 years, mean time since donation 9 years) were recorded in the both the statewide database and the Living Kidney Donor Registry (LKDR) @ANZDATA. Changing to a single, statewide follow-up centre achieved 50-70% of follow-up every year from 2014-17. This ranged from 75% at one year post-donation, 61% at 5 and 48% > 5 years post-donation as recorded locally in 2017. Reporting to the LKDR was lower at 25%, 33% & 22% respectively. From the ANZDATA follow up, 63 patients had a recorded systolic blood pressure measurement at their last follow up. 31% of these patients had hypertension requiring anti-hypertensive medication with 1.3 the average number of agents required.

Conclusions: The results show that clinical follow up decreases as time post donation increases. Statewide coordination of donor follow-up improved baseline results but there is still further improvement to be made. There is discrepancy between local data and ANZDATA. Better coordination of these two entities would allow for more accurate follow up data to be published.