A parallel evaluation of short- and mid-term changes of ambulatory blood pressure in kidney transplant recipients and kidney donors

Abstract

Introduction Kidney transplantation (KTx) is associated with improved BP levels for kidney transplant recipient (KTRs), without evoking significant changes in donors. However, there is a paucity of studies offering simultaneous detailed evaluation of BP profiles over time in transplant donor-recipient pairs. Aim of the present study was the parallel evaluation of ambulatory BP levels and trajectories in ΚTRs and their respective living kidney donors at the short-term and mid-term following KTx. Methods The study enrolled 40 prospective adult KTRs and their 40 respective donors. All participants were evaluated with 24-h ABPM (Mobil-O-Graph-NG device) at 3 time-points: baseline (1 month before KTx), 3-months and 12-months after KTx. Results In KTRs, 3-month 24-h SBP was marginally and 12-month 24-h SBP significantly reduced compared to baseline [131.9 ± 13.3 vs 126.4 ± 11.9mmHg; (p = 0.075) and 123.9 ± 10.3mmHg; (p = 0.009), respectively]. 24-h DBP was significantly reduced at both the 3-month and 12-month time-points [86.7 ± 11.5 vs 82.2 ± 8.1mmHg; (p = 0.043) and 80.3 ± 8.5mmHg; (p = 0.011)]. Similar observations were made for day- and nighttime SBP/DBP. Repeated-measures ANOVA showed a significant gradual decrease over time in mean 24-h SBP (F[1.463, 39.505] = 3.616, p = 0.049, partial η2 = 0.118) and DBP(F[1.374, 37.089] = 11.34, p = 0.055, partial η2 = 0.116). In contrast, in kidney donors 24-h SBP [118.5 ± 11.6 vs 118.2 ± 12.8mmHg (p = 0.626) and 119.2 ± 11.4mmHg; (p = 0.748)] and DBP did not change at 3 or 12 months compared with baseline; repeated-measures ANOVA showed no differences in the mean 24-h SBP/DBP levels over time. The number of antihypertensive agents declined in KTRs and remained stable in donors. Conclusions KTx reduces ambulatory BP levels and trajectories in KTRs at 3 months and further so at 12 months post-surgery. Kidney donation does not affect the ambulatory BP levels and trajectories of donors at the same intervals.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…However, the residual CV risk remains significantly higher in kidney transplant recipients than in the general population, and CVD remains the leading cause of death in these patients during the 10 years posttransplant [1429]. Kidney transplantation 'per se' is associated with significant BP reductions (24 h BP -8/ -5 mmHg) in the short-term and mid-term posttransplant periods as well as with reduction in the use of antihypertensive agents [1430,1431]. ABPM values in transplanted patients are significantly lower than those of matched hemodialysis patients and similar to patients with CKD and matched kidney function [1432].…”

A European Renal Association (ERA) synopsis for nephrology practice of the 2023 European Society of Hypertension (ESH) Guidelines for the Management of Arterial Hypertension

“…The 2023 ESH Guidelines also discuss in considerable length the management of hypertension in kidney transplant recipients (KTRs) [ 1 ]. The guidelines discuss that kidney transplantation per se is associated with significant improvements in BP (8/5 mmHg in ambulatory BP) in the short- and mid-term post-transplant periods along with reduction in antihypertensive agents [ 103 , 104 ]; as such, ambulatory BP in KTRs is significantly lower than that in carefully matched hemodialysis patients and similar to patients with CKD with matched kidney function [ 105 , 106 ]. Despite these improvements, hypertension represents the most prevalent comorbidity post transplantation, with ABPM studies estimating hypertension prevalence in >95% of KTRs [ 107 ].…”

Hypertonietherapie bei Nierenerkrankungen

“…Die Grundlage für das Blutdruckmonitoring und die Therapie sollte auch bei nierentransplantierten Patienten die ABDM sein [9]. Häufig wurde beobachtet, dass nach einer Nierentransplantation ein leichter Rückgang des Blutdrucks auftritt [51]. Trotzdem ist der Bluthochdruck bei nierentransplantierten Patienten, mit einer Prävalenz von bis zu 90 %, ein entscheidender Risikofaktor für die Mortalität und bedarf deshalb besonderer Aufmerksamkeit [51].…”

“…Häufig wurde beobachtet, dass nach einer Nierentransplantation ein leichter Rückgang des Blutdrucks auftritt [51]. Trotzdem ist der Bluthochdruck bei nierentransplantierten Patienten, mit einer Prävalenz von bis zu 90 %, ein entscheidender Risikofaktor für die Mortalität und bedarf deshalb besonderer Aufmerksamkeit [51]. Ursächlich für die Hyper tonie sind in disem Fall die Aktivierung des RAS, Natrium-und Flüssigkeitsretention, die Sympathikusaktivierung und unerwünschte Wirkungen der immunsuppressiven Therapie.…”