- Enter the living-donor candidate's baseline characteristics: age, sex, race, eGFR, systolic blood pressure, antihypertensive use, BMI, diabetes, current smoking, and albuminuria (urine ACR).
- The tool classifies the candidate's baseline projected ESRD risk tier (the risk without donation) and counts how many adverse risk factors are present. The tier updates automatically as you change any field.
- For the exact projected 15-year and lifetime percentage, open the authoritative OPTN/UNOS tool at transplantmodels.com/esrdrisk — it implements the full Grams (NEJM 2016) competing-risk model. This page deliberately does not reproduce that exact percentage.
- Remember the projection is pre-donation baseline risk. Donation incrementally raises lifetime ESRD risk above this baseline, so the post-donation figure is higher.
All computation runs in your browser; no values are stored or transmitted.
When to Use
Use this tool during the evaluation of a prospective living kidney donor to frame the candidate's baseline (pre-donation) long-term risk of ESRD. KDIGO and OPTN policy require that programs assess and disclose this projected risk during informed consent. The Grams (NEJM 2016) model — the basis of the OPTN/UNOS calculator at transplantmodels.com — projects the candidate's 15-year and lifetime risk of kidney failure in the absence of donation, which programs then weigh against their acceptance thresholds (and against the incremental risk that donation itself adds).
Appropriate population
Adults being evaluated as prospective living kidney donors, where the transplant team needs a structured baseline-risk estimate to support candidate counseling and the program's acceptance decision. Useful as a quick triage of who is clearly low-risk versus who carries adverse factors that warrant the exact projected percentage and a careful program discussion.
When NOT to rely on it
This page is a risk-factor classifier and counseling aid — not a substitute for the exact projected percentage. It does not reproduce the Grams competing-risk model's calibrated 15-year/lifetime numbers; for those, use the authoritative tool at transplantmodels.com. The model estimates baseline risk without donation, not the post-donation risk (which is higher). It was derived predominantly in US/general-population cohorts and may not transport perfectly to all populations. It does not replace program-specific policy, complete medical evaluation, or individualized informed consent.
Pearls & Pitfalls
Baseline risk is reassuringly low in healthy candidates
In the Grams model, a healthy 40-year-old's projected 15-year ESRD risk in the absence of donation is very low — about 0.24% in Black men, 0.15% in Black women, 0.06% in White men, and 0.04% in White women. These published reference values anchor counseling: most acceptable candidates sit near this floor, and adverse factors move the estimate upward.
The factors that raise projected risk
Risk rises with lower eGFR, higher albuminuria, hypertension (and antihypertensive use), diabetes, obesity, current/former smoking, younger age (more years of follow-up at risk), male sex, and Black race. The model accounts for the competing risk of death, so its lifetime estimates are not simply 15-year risk scaled up. Diabetes and clearly reduced eGFR are, in most programs, near-absolute contraindications regardless of the computed number.
Pitfalls
(1) This tool gives a risk tier, not the exact percentage — always obtain the calibrated 15-year/lifetime figure from transplantmodels.com before counseling on numbers. (2) It estimates pre-donation baseline risk; donation adds incremental lifetime risk on top, so do not present the baseline as the post-donation risk. (3) A "low" projected risk does not by itself clear a candidate — anatomy, hereditary disease (e.g., relatives with ADPKD or APOL1-related disease), psychosocial factors, and program policy all matter. (4) Garbage in, garbage out: use a reliable measured/estimated GFR and a confirmed urine ACR, not single transient values.
Why Use It
Living kidney donation asks a healthy person to accept a small but real long-term risk for someone else's benefit, so quantifying that risk is an ethical and regulatory cornerstone of donor evaluation. Before the Grams (NEJM 2016) framework, programs counseled donors with crude, population-average figures. The model — calibrated to US ESRD incidence and accounting for the competing risk of death — projects an individual candidate's 15-year and lifetime risk of kidney failure in the absence of donation from ten baseline characteristics, giving the team and the candidate a concrete, individualized baseline against which the incremental risk of donation can be weighed. KDIGO's living-donor guideline and OPTN policy explicitly endorse using this projected baseline risk during evaluation and informed consent. This page operationalizes that thinking quickly, then routes you to the authoritative calculator for the exact number.
Living Kidney Donor — Baseline ESRD Risk Classifier
Enter the prospective donor's baseline characteristics. This tool classifies the candidate's pre-donation projected ESRD risk tier and counts adverse factors. It does not compute the exact Grams-model percentage — for that, use the authoritative OPTN/UNOS calculator linked in the result.
This tool gives a risk tier, not the calibrated number. Open the authoritative OPTN/UNOS ESRD Risk Tool — which implements the full Grams (NEJM 2016) competing-risk model — to obtain the exact 15-year and lifetime projected baseline ESRD risk:
Open transplantmodels.com/esrdrisk →
⚕ Risk factors and reference values from Grams ME, et al. N Engl J Med. 2016;374(5):411–421. This page is a qualitative risk-factor classifier and counseling aid for licensed clinicians — it does not reproduce the Grams model's calibrated 15-year/lifetime percentages. It estimates baseline (pre-donation) risk only; donation adds incremental lifetime risk. Not a substitute for complete donor evaluation, program policy, or individualized informed consent.
Next Steps
Use the baseline risk tier to direct counseling and the program's evaluation pathway.
- Get the exact number. Always confirm the calibrated 15-year and lifetime projected baseline risk on the OPTN/UNOS ESRD Risk Tool before counseling a candidate on figures.
- Compare against your program's acceptance thresholds and OPTN policy. Many programs use projected-risk thresholds, often interpreted with age (a young candidate accumulates more years of risk).
- Counsel on the incremental risk of donation. The projection is baseline (without donation); donation adds lifetime ESRD risk on top of it — discuss both figures explicitly.
- Address contraindications and modifiers the model does not capture: diabetes, clearly reduced GFR, significant albuminuria, hereditary kidney disease in the family, APOL1-related risk, and psychosocial factors.
- Pair this with the Kidney Failure Risk Equation and an accurate eGFR (CKD-EPI 2021) when assessing candidate kidney function.
Evidence & References
Model & baseline reference risks
Grams et al. used meta-analyzed risk associations from seven general-population cohorts, calibrated to US ESRD and mortality incidence, and projected baseline 15-year and lifetime ESRD risk (in the absence of donation) using competing-risk methods. The model is the basis of the OPTN/UNOS calculator at transplantmodels.com. The published 15-year reference risks for a healthy 40-year-old (no risk factors) are shown below.
| Healthy 40-year-old | Projected 15-yr baseline ESRD risk |
|---|---|
| Black men | 0.24% |
| Black women | 0.15% |
| White men | 0.06% |
| White women | 0.04% |
Risk factors used in the projection
| Factor | Direction of effect on projected risk |
|---|---|
| Lower eGFR | ↑ risk |
| Higher albuminuria (ACR) | ↑ risk |
| Hypertension / antihypertensive use | ↑ risk |
| Diabetes | ↑↑ risk (usually a contraindication) |
| Obesity (higher BMI) | ↑ risk |
| Current / former smoking | ↑ risk |
| Younger age | ↑ lifetime risk (more years at risk) |
| Male sex; Black race | ↑ risk |
This page implements the published risk factors and reference values as a qualitative classifier; it does not reproduce the model's exact calibrated coefficients or percentages, which should be obtained from the authoritative calculator.
References
- Grams ME, Sang Y, Levey AS, et al. Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate. N Engl J Med. 2016;374(5):411–421. doi:10.1056/NEJMoa1510491.
- Lentine KL, Kasiske BL, Levey AS, et al. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(8S):S1–S109. (See also OPTN policy on living donor evaluation.)
- Massie AB, Muzaale AD, Luo X, et al. Quantifying Postdonation Risk of ESRD in Living Kidney Donors. J Am Soc Nephrol. 2017;28(9):2749–2755. doi:10.1681/ASN.2016101084.
