Follow-up Care of Living Kidney Donors in Alberta, Canada

Background: Previous guidelines recommend that living kidney donors receive lifelong annual follow-up care to assess renal health. Objective: To determine whether these best practice recommendations are currently being followed. Design: Retrospective cohort study using linked health care databases. Setting: Alberta, Canada (2002-2014). Patients: Living kidney donors. Measurements: We determined the proportion of donors who had annual outpatient physician visits and laboratory measurements for serum creatinine and albuminuria. Results: There were 534 living kidney donors with a median follow-up of 7 years (maximum 13 years). The median age at the time of donation was 41 years and 62% were women. Overall, 25% of donors had all 3 markers of care (physician visit, serum creatinine, albuminuria measurement) in each year of follow-up. Adherence to physician visits was higher than serum creatinine or albuminuria measurements (67% vs 31% vs 28% of donors, respectively). Donors with guideline-concordant care were more likely to be older, reside closer to the transplant center, and receive their nephrectomy in more recent years. Limitations: Our results may not be generalizable to other countries that do not have a similar universal health care system. Conclusions: These findings suggest significant evidence-practice gaps, in that the majority of donors saw a physician, but the minority had measurements of kidney function or albuminuria. Future interventions should target improving follow-up care for all donors.