Hypertension in Chronic Kidney Disease: The Influence of Renal Transplantation

Background Hypertension is one of the most prevalent cardiovascular risk factors in chronic kidney disease (CKD) and kidney transplants. The contribution of transplantation to hypertension in comparison to patients with CKD and similar renal function has not been characterized. Methods Ninety-two transplants and 97 CKD patients with an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 not receiving dialysis were enrolled. At entry, office blood pressure (BP) and 24-hr ambulatory blood pressure monitoring (ABPM) were obtained. Results Office BP was not different between transplants and CKD patients (139.5±14.3 vs. 135.2±19.3, P=1.00, respectively). ABPM 24-hr systolic blood pressure (SBP) (133.9±14.3 vs. 126.2±16.1, P=0.014), awake SBP (135.6±15.2 vs. 128.7±16.2, P=0.042), and sleep SBP (131.2±16.2 vs. 120.2 ±17.9, P=0.0014) were higher in renal transplants. When patients were classified according to BP patterns associated with highest cardiovascular risk, the proportion of patients with both nocturnal hypertension and non-dipper pattern was higher in transplants (68.5% vs. 47.4%, P=0.03). In the multivariate regression analysis, transplantation was an independent predictor of 24-hr, awake, and sleep SBP. Conclusion Office BP is similar in kidney transplants and CKD patients with similar renal function. On the contrary, hypertension is more severe in kidney transplants when evaluated with ABPM mainly as a result of increased sleep systolic BP. Thus, precise evaluation of hypertension in kidney transplants requires ABPM.

[1]  J. Banegas,et al.  Nocturnal hypertension or nondipping: which is better associated with the cardiovascular risk profile? , 2014, American journal of hypertension.

[2]  V. Mas,et al.  Impact of Calcineurin‐Inhibitor Conversion to mTOR Inhibitor on Renal Allograft Function in a Prednisone‐Free Regimen , 2013, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[3]  M. Sarwal,et al.  Complete Steroid Avoidance Is Effective and Safe in Children With Renal Transplants: A Multicenter Randomized Trial With Three‐Year Follow‐Up , 2012, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[4]  M. Zeier,et al.  Acute Effects of Calcineurin Inhibitors on Kidney Allograft Microperfusion Visualized by Contrast-Enhanced Sonography , 2012, Transplantation.

[5]  J. Fernández-Real,et al.  Reverse dipper pattern of blood pressure at 3 months is associated with inflammation and outcome after renal transplantation. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[6]  W. Nahas,et al.  Home blood pressure (BP) monitoring in kidney transplant recipients is more adequate to monitor BP than office BP. , 2011, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[7]  Giuseppe Conte,et al.  Prognostic role of ambulatory blood pressure measurement in patients with nondialysis chronic kidney disease. , 2011, Archives of internal medicine.

[8]  C. Ponticelli,et al.  Hypertension in kidney transplant recipients , 2011, Transplant international : official journal of the European Society for Organ Transplantation.

[9]  P. O S I T I O N S T A T E M E N T,et al.  Diagnosis and Classification of Diabetes Mellitus , 2011, Diabetes Care.

[10]  J. Zaltzman.  A Comparison of Short-Term Exposure of Once-Daily Extended Release Tacrolimus and Twice-Daily Cyclosporine on Renal Function in Healthy Volunteers , 2010, Transplantation.

[11]  D. Serón,et al.  Long-term graft function changes in kidney transplant recipients , 2010, NDT plus.

[12]  A. Peco‐Antić,et al.  Masked hypertension and hidden uncontrolled hypertension after renal transplantation , 2010, Pediatric Nephrology.

[13]  L. Rostaing,et al.  A Phase III Study of Belatacept‐based Immunosuppression Regimens versus Cyclosporine in Renal Transplant Recipients (BENEFIT Study) , 2010, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[14]  R. Light,et al.  GFR, proteinuria and circadian blood pressure. , 2009, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[15]  F. Massarino,et al.  Association of Arterial Hypertension With Renal Target Organ Damage in Kidney Transplant Recipients: The Predictive Role of Ambulatory Blood Pressure Monitoring , 2009, Transplantation.

[16]  G. Bakris,et al.  Hypertension awareness, treatment, and control in chronic kidney disease. , 2008, The American journal of medicine.

[17]  Jan A. Staessen,et al.  Daytime and Nighttime Blood Pressure as Predictors of Death and Cause-Specific Cardiovascular Events in Hypertension , 2008, Hypertension.

[18]  Michael Böhm,et al.  2013 ESH/ESC Guidelines for the management of arterial hypertension , 2007, Blood pressure.

[19]  R. Wyatt,et al.  Predominance of nocturnal hypertension in pediatric renal allograft recipients * , 2006, Pediatric transplantation.

[20]  G. Opelz,et al.  Improved Long‐Term Outcomes After Renal Transplantation Associated with Blood Pressure Control , 2005, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[21]  C. Palmer,et al.  Clinical significance of renal function in hypertensive patients at high risk: results from the INSIGHT trial. , 2004, Archives of internal medicine.

[22]  M. Nieminen,et al.  Albuminuria and Cardiovascular Risk in Hypertensive Patients with Left Ventricular Hypertrophy: The LIFE Study , 2003, Annals of Internal Medicine.

[23]  R. Collins,et al.  Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies , 2002, The Lancet.

[24]  Thomas G. Pickering,et al.  What is the white-coat effect and how should it be measured? , 2002, Blood pressure monitoring.

[25]  L. Miller.  Cardiovascular Toxicities of Immunosuppressive Agents , 2002, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[26]  R. Oberbauer,et al.  SIROLIMUS ALLOWS EARLY CYCLOSPORINE WITHDRAWAL IN RENAL TRANSPLANTATION RESULTING IN IMPROVED RENAL FUNCTION AND LOWER BLOOD PRESSURE1,2,10 , 2001, Transplantation.

[27]  M. Joffe,et al.  Arterial hypertension and renal allograft survival. , 2000, JAMA.

[28]  D. Sobotova,et al.  [Hypertension after kidney transplantation]. , 1999, Vnitrni lekarstvi.

[29]  A. Levey,et al.  A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation , 1999, Annals of Internal Medicine.

[30]  R. Victor,et al.  Sympathetic neural mechanisms of cyclosporine-induced hypertension. , 1996, American journal of hypertension.

[31]  G. Reboldi,et al.  Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. , 1994, Hypertension.

[32]  J. Burke,et al.  Renal function in patients receiving long-term cyclosporine therapy. , 1994, Journal of the American Society of Nephrology : JASN.

[33]  Clyne,et al.  Hypertension in Diabetes Study (HDS): I. Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovascular and diabetic complications. , 1993, Journal of hypertension.

[34]  Curtis Jj.  Hypertension after renal transplantation. , 1984, The Alabama journal of medical sciences.

[35]  H. Matsuoka.  [Masked hypertension]. , 2014, Nihon rinsho. Japanese journal of clinical medicine.

[36]  Jackson T. Wright,et al.  ORIGINAL INVESTIGATIONS Pathogenesis and Treatment of Kidney Disease Hypertension Awareness, Treatment, and Control in Adults With CKD: Results From the Chronic Renal Insufficiency Cohort (CRIC) Study , 2010 .

[37]  Eld,et al.  COMPARISON OF MORTALITY IN ALL PATIENTS ON DIALYSIS , PATIENTS ON DIALYSIS AWAITING TRANSPLANTATION , AND RECIPIENTS OF A FIRST CADAVERIC TRANSPLANT , 2000 .

[38]  G. Opelz,et al.  Association of chronic kidney graft failure with recipient blood pressure. Collaborative Transplant Study. , 1998, Kidney international.