Changes of blood pressure and left ventricular mass in pediatric renal transplantation

Abstract

Cardiovascular events are among the most frequent causes for long-term morbidity and mortality in children after renal transplantation. The aim of this study was to analyze the effects of post-transplant changes in arterial hypertension, as assessed by 24-h ambulatory blood pressure measurement (ABPM), on myocardial architecture, as assessed by echocardiography. In a retrospective chart review analysis, 39 children were identified in whom 24-h ABPM and echocardiography had been assessed within a 3-month interval after a mean of 4 years post transplantation; 20 repeated pairs of measurements after a mean of 2 years of follow-up were available to analyze the longitudinal effects of post-transplant changes of blood pressure control on left ventricular mass index (LVMI). Arterial hypertension (59%) and left ventricular hypertrophy (50%) were highly prevalent in children after renal transplantation. Renal allograft function and number of antihypertensive medications, but not ABPM variables, were correlated with LVMI at the initial observation. However, at repeat assessment, a significant correlation between ABPM and LVMI was found. In the longitudinal assessment, left ventricular remodeling was dependent on change of dosage of cyclosporine and interval changes of blood pressure levels. Hence, control of blood pressure correlates with changes of LVMI in children with renal allografts. These results clearly underline the importance of blood pressure control for the maintenance of the myocardial architecture.

Outcome after renal transplantation in children from native and immigrant families in Austria

“…The glomerular filtration rate (GFR) was computed using the Schwartz formula [GFR (ml/min/ 1.73 m 2 )=0.55×body length (cm)/serum creatinine (mg/dl)]. The blood-pressure index was computed by dividing the mean patient values of the last 24-h ambulatory blood pressure measurement (ABPM) by the 95th percentiles based on the reference values for mid-European children [12]. The standard deviation scores (SDS) of height were calculated ([observed height of the patient−expected height for age]/standard deviation of the mean height for age) for the first day of transplantation and the last day of follow-up.…”

Improved left ventricular mass index in children after renal transplantation

“…Other groups have reported a high prevalence of LVH in children after renal transplantation, but at least half of the patients were hypertensive, and some also had marked anemia [5,7]. The majority of the patients described in these reports were on cyclosporine-based immunosuppression, and all of the studies were cross-sectional.…”

“…Left ventricular hypertrophy (LVH) is the most common cardiac abnormality observed in pediatric and adult dialysis patients, and has been associated with hypertension and volume overload [3]. However, LVH is prevalent even after successful RTx, in between 7% and 82% of children in various cross-sectional studies [4][5][6][7][8]. LVH is a significant risk factor for cardiovascular mortality, both in the general population and in patients with renal disease [9].…”

Cardiovascular Disease in Children with Chronic Kidney Disease

“…A Midwest Pediatric Nephrology Consortium study, 21 utilizing data from six centers, demonstrated the prevalence of LVH to be 40% in children 1-year post-transplant. Most of these studies show the persistence of cardiac hypertrophy, [32][33][34] but some report improvement post-transplant. 35 As in adults, hypertension is the main cause of cardiac hypertrophy in children before ESRD or post-transplant.…”