Dr. Jerry McCauley obtained his undergraduate and medical degree at Dartmouth and completed his MPH at the University of Pittsburgh. He has been a faculty member at Tufts University and the University of Pittsburgh.
Dr. McCauley rose through the ranks at the University of Pittsburgh where he became Director of Transplantation Nephrology, Medical Director of the Kidney/Pancreas and Islet Cell Transplantation Program, and Professor of Medicine and Surgery. Since 2013 he has been the Chief of Nephrology at Thomas Jefferson University in Philadelphia.
WHAT YOU NEED TO KNOW ABOUT KIDNEY FAILURE
Why do African-Americans have a far greater risk of developing kidney failure than others?
African-Americans have three times more risk of developing kidney disease than whites. This is primarily due to high rates of diabetes and hypertension which are the leading causes of kidney failure for all Americans. They also have more frequent diseases like lupus which can cause kidney failure. Other diseases of the filtering units in the kidney (glomerulus) are more common and severe in African-Americans. Focal segmental glomerulosclerosis is the most common and severe form of these diseases.
How many African-Americans are waiting for kidney transplants?
There are approximately 100,000 people waiting for kidney transplants in the US and about 35% are African-Americans so that about 35, 000 African-Americans are waiting for kidney transplants.
How are donor kidneys allocated and are there enough available?
Deceased donor kidneys are allocated by a point system which is based on a set of donor and patient characteristics. Kidneys are not matched by race such that African-Americans are more likely to get a kidney from a White person than from an African-American.
Factors included in giving points included the time on dialysis, and others. The new allocation system effectively matches donor and recipient by age and other factors by a calculation termed the Kidney Donor Profile Index (KDPI) which estimates the risk of kidney failure compared to the average donor. Very low numbers (20% and less) typically goes to young people based upon another calculation termed the Estimated Post Transplant Survival (EPTS) which estimates patient survival after transplant.
Factors included in the EPTS are 1) Candidate time on dialysis, 2) Current diagnosis of diabetes, 3) Prior solid organ transplants, 4) Candidate age. Points are also given for prior organ donors and for patients who have a large number of antibodies against potential donors (sensitized patients).
These sensitized patients seldom were transplanted with the old system and now are transplanted rapidly. Kidneys from Public Health System (PHS) High Risk categories can be allocated to anyone regardless of age but the patient must declare that they are interested in this type of donor.
Typically these donors are opioid users and others at risk of hepatitis or HIV. They are screened for these diseases before transplantation and patients with HIV are not used except for a special study which is available in a limited number of centers. Hepatitis B or C positive donors may be offered to patients who are already positive for these viruses.
Are there enough donors?
No. In 2016 only about 19,000 kidneys were transplanted for a waitlist of about 100,000.
How can family and friends find out if they’re eligible?
For willing donors the only way to find out if you are a potential donor is to tell the patient that you are willing to donate. After this important step you should contact the transplant center to be certain if you qualify. You should not decide on your own. The center will be best in determining if you are healthy enough to donate or if any health problems would prohibit it.
The new allocation system gives points from the time a patient starts dialysis instead of when they complete all the tests needed to be listed. This has been a major aid in African-Americans getting on the list. Previous allocation systems did not use the KDPI or EPTS to allocate organs and tissue typing derived points have been li
mited to only one locus instead of three. Sensitized patients now get points from lower numbers starting with zero. The old system only gave points once the patients were 80% sensitized. As mentioned earlier, it approximately matches donors and recipients by age so that a 20-year-old donor kidney will not usually go to a 75-year-old recipient since that 20-year-old kidney is expected to give more years of functioning than the patient is expected to live. The PHS high risk kidneys can go to older patients and many of these transplants have been done with very low rates of disease transmission.
What is the average waitlist time?
Nationally, the average waitlist time is about 3 ½ years but this varies by geographic area and transplant center. In some centers the wait for a deceased donor may be a bit more than a year and in others it may be ten years. It is important for patients to inquire at the transplant center about their particular wait time. The best way to avoid waiting for a kidney transplant is to get a living donor kidney transplant.
Do kidney donors and recipients have to be the same race?
No. Race is not a factor in selecting or matching kidney transplants.
Is there a difference between a kidney from a living donor or a deceased donor?
Yes. Living donor kidney tend to function immediately after transplantation and last years longer. This is true whether the kidney comes from a relative or someone unrelated. When possible, patients should receive a living donor transplant. The waiting times for deceased donors do not apply to living donation in that the donor and recipient can schedule the transplant like any other elective medical treatment instead of waiting for some unknown period of time.
What if I donate a kidney and later need a kidney transplant?
In such cases the former donor is given a large number of points on the waiting list which allows them to be transplanted much quicker than the average patient. It is very important to avoid this situation. Donors are healthy at the time of donation and should practice measures to remain healthy.
Diabetes and hypertension are the leading causes of kidney failure nationally. These two diseases often develop when patients become obese. It is vital that donors (and non-donors) maintain healthy body weight. Weight gain can cause diabetes and hypertension. Donation will not cause these illnesses but will not protect you if you gain excessive weight
Dr. McCauley answers your Text Tom questions below:
I am 53 years old. Would my age disqualify me from donating my kidney?
Based upon your age alone, yes. Although your kidney function can decrease with age, most transplant centers determine what your actual kidney function is when deciding if you can be, a kidney donor. Some patients in their 70s have been able to donate their kidneys.
Does high blood pressure medication cause kidney damage?
High blood pressure medicines do not cause kidney damage. In fact, using high blood pressure medicines can prevent you from developing kidney failure. Some high blood pressure medication used in diabetics with protein in the urine can cause the kidney test to increase but this is not damaging the kidney. These medications are called angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.
These medications can actually slow deterioration of the kidneys. A common medication and these classes include Lisinopril. If your creatinine (which is the kidney test) increases too much after starting a medication like lisinopril it may be discontinued. When this happens the creatinine test returns to its previous value without causing any permanent damage to the kidney.
Is it true that you have to pay $10,000 for a kidney transplant?
Kidney recipients do not have to pay $10,000 for a kidney. In America it is against the law to sell organs. Insurance will pay for their kidney transplant just like any other medical procedure. Some people travel abroad and pay to have an illegal kidney transplant. When this is done, they may pay as much as $10,000 dollars. This is called medical tourism and in the case of kidney transplantation, it may be very unsafe. Patients have developed serious infections due to poor screening of the organ donor and others have died due to substandard medical care.
What did the doc say to stay away from to keep your kidney healthy?
I said you should stay away from salt and avoid weight gain.
How do you know when your kidneys are going bad?
The most common way to determine if your kidneys have problems is by a laboratory test. Many people find out on routine laboratory testing that their kidneys are not normal. The vast majority of people do not have symptoms of chronic kidney disease. Only at the very last stages of kidney failure do symptoms developed. At this point it is typically time to start dialysis. It is therefore important to have routine visits with your doctor and have the kidney test performed during these visits.
Is it true Black men can live off of 20% of a kidney without dialysis?
Once your kidney function decreases to about 20 percent, you are getting close to dialysis but it’s usually do not needed at that time. It is not true that Black man in particular live off 20 percent of their kidney function. Anyone can live with 20 percent of the remaining kidney function, but typically once you get to such low levels you will require dialysis at some point.
Can chronic kidney disease be reversed and if so, how?
Most chronic kidney diseases cannot be reversed. The most common causes of chronic kidney disease are hypertension and diabetes. Once the damage has occurred, it is unlikely things will improve. There is typically permanent scarring in the kidney and this will not improve.
There are some forms of sudden kidney failure which can improve. This is termed acute renal failure and this typically occurs when someone drops their blood pressure to very low levels and the kidneys sustain temporary damage. Physicians will call this acute tubular necrosis and the expectation is that the kidneys were will recover function usually within 2 weeks.
What is the cutoff age for getting a transplant if you have a willing donor?
Some centers use a cutoff age for people needing a kidney transplant. The vast majority of programs do not. Many patients in their 70s and 80s have received kidney transplants. Transplant centers will determine if you are healthy to undergo a kidney transplant regardless of your age.
I’m a transplant recipient. I have had my kidney for 13 years from a cadaver. What’s the life expectancy of a cadaver kidney transplant?
Deceased donor kidneys can last for decades if patients take proper care of them. It is very important to take your medications as prescribed. In particular, it is very dangerous to skip or stop anti-rejection medications. If medications are skipped are stopped, one can developed a full-blown rejection which can place you on dialysis immediately. For others, the kidney test deteriorate slowly and the kidney fails prematurely. So when someone asks me how long will my kidney last, I say it depends on how well you take care of it.
Is there any requirement for doctors to ask the family of the deceased about organ donations?
Yes. If the donor has not confirm that they want to donate on their driver’s license or some other form, it is absolutely required that legal consent be obtained by the next of kin. When the donor has already declared that they want to donate and it is present on their driver’s license or some other legal form, then the wishes of the donor is taken into account.
What is the average age that kidneys start going bad?
The most common age for African-Americans is in the late 40s to early 50s, when total numbers are considered. Kidney failure increases as we get older so that the risk of kidney failure goes up as we reach our 60s and 70s.
I’m Mimi from Philly. My daughter and I have FSGS. My mother, who is deceased, was on dialysis for 18 years. Do you agree that kidney disease is hereditary? My siblings were told years ago that kidney disease was not hereditary.
Many types of kidney diseases are not hereditary. But there are some that are clearly hereditary. FSGS is hereditary in some patients. Many of them however do not have a hereditary basis for their disease.
I’m on dialysis but my blood pressure is low. How can i raise it?
First, I would have a discussion with your nephrologist about the specific causes of your low blood pressure. There are medications that can be used which sometimes help increase the blood pressure in dialysis patients. Rather than giving you a list of medications now, please discuss this in detail with your nephrologist.
I have a friend who is a doctor that needs a kidney. We are the same blood type B+. However, I have some of the same issues that got him there. I have been cautioned that it may not be a good thing for me to donate. Your thoughts?
Without knowing the details, it probably makes sense for you not to donate. I would however have a discussion with the friend and see if he would be willing to have you evaluated at a transplant center.
My sister is a dialysis patient. She takes dialysis 3 times a week, however she has fluid building up in her legs and her ankles. What could be the cause ? We watch her diet closely and the sodium intake. The doctors cannot get this under control .. she’s 75.
There are many causes of ankle swelling or edema in dialysis patients. The most common is too much weight gain between dialysis treatments. In others, there may be a low protein concentration in the blood, heart failure or other medical problems. I would not be able to tell you specifically what is the cause in your sister but would urge you to discuss this in detail with your nephrologist and potentially have a second opinion if you need additional information.
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