DEAR MAYO CLINIC: I was surprised to learn that even though I have type 2 diabetes, I possibly could be a candidate to donate a kidney to my husband who has end-stage kidney disease. Would donating a kidney be safe for me and my husband? I thought diabetes could cause kidney failure. 

ANSWER: Thank you for considering the gift of life through organ donation. I am wishing all the best to you and your husband. 

You are correct; diabetes is the top cause of kidney failure. This is why patients with type 2 diabetes previously were ruled out as potential living kidney donors. However, the Organ Procurement and Transplantation Network updated its living donor criteria to allow people with type 2 diabetes to donate a kidney if there is no evidence of organ damage or an unacceptable lifetime risk of complications. 

The major benefit of this policy change is to open up the door for those who would like to be living kidney donors who could not be donors in the past. This can increase the pool of potential living kidney donors and be a lifeline to many people who suffer from end-stage kidney disease. 

Mayo Clinic Transplant Center also adopted its own more stringent policies to minimize potential risks. In addition to national criteria, Mayo Clinic patients with type 2 diabetes also must meet the following criteria to be a donor:

• Be age 60 or older.
• Have well-controlled diabetes and not use insulin.
• If over age 65, can be using up to two oral medications for diabetes.
• Not be overweight.
• Have no family history of kidney disease.
• Undergo a thorough health assessment and individualized risk evaluation.

People with type 1 diabetes, however, remain ineligible to be a living kidney donor.

About 89,000 people are on the U.S. waiting list for a kidney transplant, according to the United Network for Organ Sharing. 

Unfortunately, kidney disease usually is irreversible and continues to worsen over time. While some types of acute kidney injury may recover, in general, chronic kidney disease is a progressive disease that leads to dialysis or the need for a kidney transplant.

If someone is facing end-stage disease, one option is to go through dialysis, which temporarily replaces kidney function. That can be done through the blood, called hemodialysis, or through the abdomen, called peritoneal dialysis. However, a kidney transplant is the gold standard treatment because studies show transplant patients live longer and have a better quality of life than those on dialysis. 

Receiving a living kidney donation also typically is faster than a deceased donor kidney, with arrangements taking weeks to months for a living kidney donation compared with an average wait of several years for a deceased donor kidney. Research has shown that people who receive a kidney from a living donor kidney have better outcomes than those who have a deceased-donor kidney transplant.

Kidney transplant surgery is done through a minimally invasive, laparoscopic approach through small incisions in your abdomen using surgical instruments and a thin tube with a camera on the end called a laparoscope. Patients typically have a short hospital stay and less pain than after an open surgery. Many donors return to work and their activities a few weeks after donating a kidney. — Naim Issa, M.D., Nephrology, Mayo Clinic, Rochester, Minnesota

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Dr. Naim Issa, a Mayo Clinic transplant nephrologist, says there are some common myths regarding living kidney donations that may be holding some people back.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:05) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"We would like people to consider living kidney donation because it saves lives. We can get people better matched kidneys through a larger pool of donors," says Dr. Issa.

He says a common misconception is that a kidney donor needs to be a first-degree relative.

"Anyone can be a living kidney donor and does not need to be relative. It can be unrelated, can be an acquaintance or can be anyone," says Dr. Issa.

Another myth is the donor kidney needs come from a person of the same race.

"A kidney is a kidney. It doesn't matter whatever race you are; you should consider living kidney donation," says Dr. Issa.

He says if you're worried that you might be too old to donate, you shouldn't. If you're healthy and over 18, you might be a match.

"In general, we typically say up to 70 years, but, in fact, there is no age limit for living kidney donation," says Dr. Issa.

Up until recently, anyone with type 2 diabetes was ruled out as a living donor. But now, based on certain health requirements, some of those candidates may be eligible.

"By expanding the criteria to allow more individuals with type 2 diabetes to be potential donors, we can close the gap between the high demand for organs and the need for kidney transplants," says Dr. Issa.

The post Mayo Clinic Minute: Reasons to be a living kidney donor appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — People who are overall healthy and living with well-controlled Type 2 diabetes can donate a kidney, thanks to a change in national policy.

The Organ Procurement and Transplantation Network updated its living donor criteria. It makes some people with Type 2 diabetes eligible to donate a kidney. This marks a "significant shift" in criteria for living kidney donors, says Naim Issa, M.D., Mayo Clinic transplant nephrologist.

"This policy change may offer a lifeline to some people with end-stage kidney disease, providing them with a better chance for a successful transplant and improved quality of life," he says.

Nearly 89,000 people in the U.S. are on the waiting list for a potentially lifesaving kidney transplant, according to the United Network for Organ Sharing. The average wait for a kidney from a deceased donor is three to five years. People who receive kidneys from living donors also tend to have better outcomes, says Shennen Mao, M.D., Mayo Clinic transplant surgeon.

"People in need of a kidney transplant typically receive a living donor transplant much faster than a deceased donor transplant, avoiding many years of dialysis and its associated complications," Dr. Mao says. "On average, kidneys from living donors also last longer than those from deceased donors."

What led to policy change?

Historically, people with diabetes have been prohibited from being living kidney donors because diabetes can cause kidney disease. People with Type 1 diabetes remain ineligible to be a living kidney donor. By expanding eligibility criteria, there's potential to save more lives through increased kidney availability while maintaining a commitment to the safety and well-being of donors.

What is the policy?

The national policy allows people with Type 2 diabetes to donate a kidney if there is no evidence of organ damage or an unacceptable lifetime risk of complications. Mayo Clinic Transplant Center adopted its own more stringent policies to minimize potential risks for the donor. In addition to national criteria, Mayo Clinic patients with Type 2 diabetes also must meet the following criteria to be a donor:

• Be age 60 or older.
• Have well-controlled diabetes and not use insulin.
• If over age 65, can be using up to two oral medications for diabetes.
• Not be overweight.
• Have no family history of kidney disease.
• Undergo a rigorous health assessment and individualized risk evaluation.

"Mayo Clinic donors undergo thorough health evaluations and risk assessments, ensuring that only those with minimal risk of complications are approved to donate," says Pooja Budhiraja, M.B.B.S., Mayo Clinic nephrologist. "Criteria such as age limits, weight requirements and the absence of a family history of kidney disease help mitigate the long-term health risks for donors. Our commitment is to safeguard donor health while expanding transplant possibilities."

Mayo Clinic will also conduct ongoing research to monitor and assess the effect of these policy changes on the long-term outcomes of older living kidney donors with Type 2 diabetes.

Mayo Clinic Transplant Center is the largest integrated transplant center in the U.S. Learn more about becoming a living kidney donor.

Watch: Mayo Clinic Minute: Expanding the living kidney donor pool to those with Type 2 diabetes

Journalists: Broadcast-quality video pkg (1:08) is in the downloads at the end of the post. Please "Courtesy: Mayo Clinic News Network." Read the script.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Heather Carlson Kehren, Mayo Clinic Communications, newsbureau@mayo.edu

The post Type 2 diabetes no longer a barrier to becoming a living kidney donor appeared first on Mayo Clinic News Network.

Dr. Naim Issa, a Mayo Clinic transplant nephrologist, says, until recently, patients with Type 2 diabetes have been ruled out as potential living kidney donors. Now, following strict criteria, some patients may be eligible to help close the gap on this ever-growing need for living kidney donors. 

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:08) is in the downloads at the end of the post. Please "Courtesy: Mayo Clinic News Network." Read the script.

Every eight minutes, a person is added to the national kidney transplant waiting list. 

"Unfortunately, in this country, there is a large gap between the demand for kidney transplantation and the supply of organs from deceased donors," says Dr. Issa.Dialysis is an option for patients with end-stage kidney disease. Though Dr. Issa says a transplant is preferred — and having a living donor is best.

"Kidney transplantation offers greater survival benefits and increases the lifespan of people in need of kidney transplant," he says.

And that's a reason why it's important to expand the eligible kidney donor pool.

"Allowing people with Type 2 diabetes mellitus may open the door for some people who have not been eligible before to be potential living kidney donors," Dr. Issa says.

Criteria for a living kidney donor with Type 2 diabetes

Those eligible must be older than 60, have well-controlled Type 2 diabetes, not on insulin and have no family history of kidney disease.

"Any potential individual who would like to be a candidate for living kidney donation should undergo a very thorough health assessment and very thorough examination to ensure they are healthy enough," says Dr. Issa.

It's about safeguarding the potential donor's overall health — while helping close the gap.

Learn more about what it means to be a living kidney donor.

Read the news release: Type 2 diabetes no longer a barrier to becoming a living kidney donor

The post Mayo Clinic Minute: Expanding the living kidney donor pool to those with Type 2 diabetes appeared first on Mayo Clinic News Network.

What if those people could be treated with medication that could slow the progression of their disease, and help avoid the need for dialysis and kidney transplantation altogether?

Dr. Naim Issa, a Mayo Clinic transplant nephrologist says there is a class of medications to help people with chronic kidney disease that does just that. He says Mayo Clinic has been incorporating these medications to help patients for the last few years.

March 9 is World Kidney Day, a day aimed at raising awareness about the importance of the kidneys.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:03) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Most people don't have symptoms of chronic kidney disease until it's at an advanced stage.

"Early detection of chronic kidney disease may help us actually treat and prevent patients ahead of time before the need for dialysis or kidney transplantation," says Dr. Issa.

He says a new class of drugs, SGLT2 inhibitors, is being called a game changer. The drugs were originally designed to treat diabetes — a main cause of chronic kidney disease.

Medicines in the SGLT2 inhibitor class include canagliflozin, dapagliflozin and empagliflozin.

"In large trials, we observed groundbreaking success with those medications in slowing down the progression of chronic kidney disease, to the extent of avoiding dialysis and the need for kidney transplantation," Dr. Issa says.

The medications are used whether the patient is diabetic or not.

"They are actually game-changer medications that help us prevent the progression of chronic kidney disease," says Dr. Issa.

You can help yourself by following a low-sodium, moderate-protein diet, avoid smoking and getting plenty of exercise.

Dr. Issa says it is important that patients with chronic kidney disease work with their primary care physician and health care team to monitor and check blood pressure, urine analysis and bloodwork.

Related posts:

• Lifestyle changes can be critical for kidney transplant patients’ long-term survival
• Mayo Clinic Minute: What is chronic kidney disease?
• Diets higher in calcium and potassium may help prevent recurrent symptomatic kidney stones, Mayo Clinic study finds

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was recorded prior to COVID-19 or recorded in an area not designated for patient care, where safety protocols were followed.

The post Mayo Clinic Minute: Game-changing treatment for chronic kidney disease could slow down progression of the disease appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Experts are hoping a new requirement that all U.S. transplant centers use a race-neutral formula to determine eligibility for a kidney transplant will improve African American access to lifesaving transplants.

"This is an essential step toward reducing racial inequity in access to kidney transplantation," says Naim Issa, M.D., a Mayo Clinic nephrologist. "The inclusion of race in the calculation of kidney function has been linked to disparities in care for African Americans, including delays in diagnosis of kidney disease and eligibility to be put on the waiting list for a kidney transplant."

Role of race in estimating kidney function

The new requirement, which was recently approved by the Organ Procurement & Transplantation Network's board, centers on how a patient's glomerular filtration rate, or GFR, is calculated. This rate estimates how much blood the kidneys' filtering units clean every minute based on a person's body size.

Some transplant centers, including Mayo Clinic, directly measure the glomerular filtration rate to determine a patient's kidney function. But direct measurement of kidney function is not widely available across laboratories and is cost-prohibitive for routine clinic use. Therefore, many health care professionals rely on calculated estimates of the glomerular filtration rate known as eGFR. This estimate is important because it determines whether a patient qualifies to be put on the transplant waiting list.

Some formulas commonly used to estimate kidney functions include a Black race variable. Those formulas report higher eGFRs for Black people, compared to non-Black people with similar characteristics. Recent research has found that these race-based calculations can end up overestimating a Black patient's kidney function by as much as 16%.

What change means for health equity

Racial disparities surrounding access to kidney transplants remain an issue. African Americans are more than three times as likely to have kidney failure than white people and less likely to be put on a waiting list for a kidney transplant.

Once on a waiting list, Black patients often end up waiting longer than white patients for a kidney transplant. The reason behind these disparities is complex.

African Americans are at high risk for kidney failure due in part to high rates of diabetes and high blood pressure. Recent research also has discovered a genetic predisposition to kidney disease for some people with Western African ancestry. Economic and social conditions also play a role, as does a lack of access to health care and structural racism.

"African Americans are markedly overrepresented among patients on dialysis and are less likely to be referred for or receive a kidney transplant," Dr. Issa says.

Encouraging more diverse donors

Experts are optimistic this transplant policy change will encourage more people, especially people of color, to consider becoming organ donors.

August is National Minority Donor Awareness Month. Of the nearly 90,000 people in the U.S. on the waiting list for a kidney transplant, more than one-third are Black.

While organs are not matched based on race and ethnicity, people will generally have a better chance of matching with someone from a similar racial or ethnic background. While most people in need of a transplant in the U.S. are people of color, 30% of donors come from communities of color.

Mayo Clinic has one of the largest living-donor programs in the country. People can register to become organ donors on the Donate Life America website.

Experts available

These Mayo Clinic experts can discuss the race-neutral requirement, its role in addressing racial inequities in transplants and the need for more diverse organ donors:

• Naim Issa, M.D., nephrologist at Mayo Clinic in Rochester.
• Caroline Jadlowiec, M.D., transplant surgeon at Mayo Clinic in Arizona
• Martin Mai, M.D., nephrologist at Mayo Clinic in Florida

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Heather Carlson Kehren, Mayo Clinic Public Affairs, newsbureau@mayo.edu

The post Expert Alert: What a formula change may mean for Black patients in need of a kidney transplant appeared first on Mayo Clinic News Network.

The donation of a kidney to a person in need of a transplant is one of the most profound gifts a person can offer. The process for living kidney donors is safe, and, at Mayo Clinic, which has one of the largest living-donor kidney transplant programs in the U.S., the process is rigorous in assessing and protecting the donor's health.

A very small number of living donors develop chronic kidney disease or low renal function years after donation, and Mayo researchers have been looking for clues to determine why this occurs. A CT scan can detect some abnormalities in the kidney prior to donation, but often it's unclear whether they're significant. Biopsies aren't routinely done prior to transplant, so in the rare cases of development of chronic kidney disease after donation, it's unclear whether it's related to the donor's preexisting condition or health changes later.

"What is reassuring is that our findings support the notion that living kidney donation is safe."
Naim Issa, M.D.

Mayo Clinic has a rich resource of kidney biopsy material in its Aging Kidney Anatomy Study, led by Andrew Rule, M.D., a Mayo Clinic nephrologist. A new study of living kidney donors at Mayo Clinic in Minnesota and Arizona from 1999 to 2018 has found some microstructural features that can indicate some long-term susceptibility for chronic kidney disease in otherwise healthy adults.

The study, published in Mayo Clinic Proceedings, reinforces that kidney donation is safe for living donors, and it provides new insights for counseling donors on how to take care of themselves and preserve kidney function, according to Naim Issa, M.D., a Mayo Clinic transplant nephrologist.

Read the rest of the article on Advancing the Science blog.

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Other Mayo Clinic medical research websites:

• Research at Mayo Clinic
• Discovery’s Edge
• Advancing the Science
• Forefront
• Mayo Clinic Center for Individualized Medicine
• Center for Regenerative Medicine
• Center for the Science of Health Care Delivery

The post New research shows markers in donor kidneys that could reduce risks appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Mayo Clinic researchers have discovered that subtle structural features in kidneys from living donors that can only be seen with a microscope may predict the risk of transplant failure in recipients. The findings are published online in the Journal of the American Society of Nephrology.

"We think that those subtle abnormalities in the living kidney donor may make the kidney more susceptible to fail in the future in the recipients," says Naim Issa, M.D., a Mayo Clinic nephrologist and the study's lead author. "These important findings may provide insights into unrecognized predictors of kidney transplant failure in recipients."

Last year was a record year for living organ donation in the U.S., with nearly 7,400 living donor transplants, according to the Organ Procurement and Transplantation Network. Still the number of willing donors is far less than the need. Nearly 95,000 people in the U.S. are waiting for a lifesaving kidney transplant. For patients in need of a kidney transplant, finding a living donor is usually their best option, Dr. Issa says. That is because kidneys from living donors generally last longer than those from deceased donors and living kidney donors have great outcomes after donation.

When evaluating the quality of a donated kidney, transplant experts generally rely on information such as the donor's age, risk factors and kidney function. These donors also undergo extensive medical testing to ensure they are healthy enough to be a donor. Nonetheless, some recipients experience transplant failure earlier than others.

As part of the study, a research team led by Andrew Rule, M.D., a Mayo Clinic nephrologist, and Dr. Issa evaluated 2,293 donor-recipient pairs. Biopsies were performed on the donors' kidneys after they were removed for transplantation in the recipient. Based on that research, a few structural features may affect the life span of a kidney posttransplant.

Those subtle structural features are:

• Minimal scarring of the kidney
• Hardening of the kidney's vessels
• Larger size of kidney's nephrons, which are the microscopic functional units of the kidney

"More research is needed into these subtle structural features, along with the role the immune response plays in damaging transplanted kidneys," Dr. Issa says. "Our hope is that our findings can play a role in the future to help prolong the life span of kidney transplants."

This study was supported with funding from the National Institute of Diabetes and Digestive and Kidney Diseases.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news and An Inside Look at Mayo Clinic for more information about Mayo.

Media contact:

• Heather Carlson Kehren, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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