What is the highest acceptable blood pressure (hypertension) for a potential kidney donor?

Blood Pressure Thresholds for Kidney Donor Acceptance

Normal blood pressure as defined by general population guidelines is acceptable for kidney donation, and controlled hypertension up to 140/90 mm Hg on 1-2 medications without target organ damage may be acceptable depending on the donor's overall risk profile. 1

Primary Blood Pressure Criteria

Ideal Donors (Lowest Risk)

• Normal blood pressure without medication is the gold standard for kidney donation, defined as systolic <120 mm Hg and diastolic <80 mm Hg 1
• These donors have no additional cardiovascular or renal risk from blood pressure elevation 1

Acceptable with Controlled Hypertension

• Systolic blood pressure <140 mm Hg and diastolic <90 mm Hg represents the upper acceptable limit for donors with treated hypertension 1
• Donors must be controlled on no more than 1-2 antihypertensive medications 1
• No evidence of target organ damage (left ventricular hypertrophy, retinopathy, proteinuria, or reduced kidney function) is required 1
• This threshold is based on older JNC 8 guidelines, though newer ACC/AHA guidelines suggest lower targets of 130/80 mm Hg for the general population 1

Critical Evaluation Steps

When Blood Pressure is Borderline or Variable

• Use ambulatory blood pressure monitoring (ABPM) or repeated standardized measurements when clinic readings are high-normal or inconsistent 1
• ABPM provides more accurate assessment than isolated office readings and can identify white coat hypertension 1
• This step prevents inappropriate exclusion of suitable donors with falsely elevated clinic readings 1

Individualized Risk Assessment Required

• The decision to accept donors with blood pressure 130-140/80-90 mm Hg must consider demographic factors and overall health profile 1
• African American donors with any degree of hypertension carry higher risk, as there are no safety data for nonwhite donors with predonation hypertension on medications 1
• Age >50 years, absence of obesity (BMI <30 kg/m²), and absence of diabetes improve the safety profile for hypertensive donors 1, 2

Evidence Supporting These Thresholds

Long-term Outcomes Data

• Donors with controlled hypertension (BP <140/90 mm Hg on treatment) show similar mortality, cardiovascular disease, and end-stage kidney disease rates compared to normotensive donors at 14-19 years follow-up 3
• The majority of hypertensive donors in successful donation programs were under age 50 years, white, and related to their recipient 3
• Five of 904 hypertensive donors (0.55%) developed ESKD at mean 19 years post-donation versus 39 of 7,817 normotensive donors (0.50%), showing no significant difference 3

Histological Findings

• Hypertensive donors have larger glomeruli and arterial hyalinosis on biopsy at donation, but these findings do not predict clinically significant decline in kidney function at 10 years 4
• Donors with office BP ≥140/90 mm Hg have increased risk of proteinuria long-term, warranting extended follow-up 4

Common Pitfalls to Avoid

Do Not Apply Newer Hypertension Definitions Rigidly

• The 2017 ACC/AHA definition of hypertension (≥130/80 mm Hg) came after KDIGO guidelines and should not automatically exclude donors 1, 5
• While donors meeting the 130/80 mm Hg threshold have similar renal outcomes, they show increased cardiovascular disease and diabetes risk long-term 3
• Use the 130/80 mm Hg threshold to identify donors needing more intensive cardiovascular risk counseling, not automatic exclusion 3

Recognize High-Risk Subgroups

• No safety data exist for African American or Hispanic donors with medically-treated hypertension, regardless of control level 1
• These donors may have accelerated rise in blood pressure post-donation compared to white donors 1
• Exercise extreme caution or defer donation in nonwhite candidates with any hypertension requiring medication 1

Ensure Proper Blood Pressure Measurement

• Use trained staff with calibrated equipment for all measurements 1
• Single elevated readings should never determine donor eligibility without confirmation 1

Mandatory Donor Counseling

• Inform all donors that blood pressure may rise with aging, and donation may accelerate this rise beyond normal aging expectations 1
• Counsel on lifelong lifestyle interventions: healthy diet, smoking abstinence, healthy body weight, and regular exercise 1
• These measures should begin before donation and continue indefinitely 1