Background Pre-existing chronic hypotension affects a percentage of kidney transplanted patients (KTs). Although a relationship with delayed graft function (DGF) has been hypothesized, available data are still scarce and inconclusive. Methods A monocentric retrospective observational study was performed on 1127 consecutive KTs from brain death donors over 11 years (2003–2013), classified according to their pre-transplant Mean Blood Pressure (MBP) as hypotensive (MBP < 80 mmHg) or normal-hypertensive (MBP ≥ 80 mmHg, with or without effective antihypertensive therapy). Results Univariate analysis showed that a pre-existing hypotension is associated to DGF occurrence (p<0.01; OR for KTs with MBP < 80 mmHg, 4.5; 95% confidence interval [CI], 2.7 to 7.5). Chronic hypotension remained a major predictive factor for DGF development in the logistic regression model adjusted for all DGF determinants. Adjunctive evaluations on paired grafts performed in two different recipients (one hypotensive and the other one normal-hypertensive) confirmed this assumption. Although graft survival was only associated with DGF but not with chronic hypotension in the overall population, stratification according to donor age revealed that death-censored graft survival was significantly lower in hypotensive patients who received a KT from >50 years old donor. Conclusions Our findings suggest that pre-existing recipient hypotension, and the subsequent hypotension-related DGF, could be considered a significant detrimental factor, especially when elderly donors are involved in the transplant procedure.

I disturbi dell'equilibrio idro-salino risultano estremamente comuni nei pazienti ospedalizzati, in particolar modo in quelli critici. L'ipernatremia, che può essere secondaria a sovraccarico di sodio o a perdita di fluidi ipotonici, può contribuire significativamente alla già importante morbilità e al rischio di morte di questa categoria di pazienti. Questo disturbo richiede pertanto una diagnosi tempestiva e può essere corretto con un intervento appropriato e con il trattamento dei fattori predisponenti che ne sono alla base.

Disorders of water and sodium balance are highly common in hospitalized patients, especially in those critically ill. Hypernatremia, either due to sodium overload or hypotonic water depletion, strongly contributes to the morbility and mortality of this category of patients. Therefore, this disorder requires an early diagnosis and can be solved by an appropriate therapeutic intervention and treatment of the risk factors.