Kidney transplantation and kidney donation do not affect short-term blood pressure variability

Xagas, Efstathios; Sarafidis, Pantelis; Iatridi, Fotini; Theodorakopoulou, Marieta; Pella, Eva; Korogiannou, Maria; Argyris, Antonis; Protogerou, Athanase D.; Boletis, Ioannis; Marinaki, Smaragdi

doi:10.1080/08037051.2023.2181640

Cited by 3 publications

(1 citation statement)

References 44 publications

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“…In a comparative study of KTR and CKD patients (matched for age, sex, and estimated glomerular filtration rate, n = 93 per group) BP levels, BP trajectories, and short-term BP variability indices were not different between KTR and CKD patients except for a slightly higher nighttime diastolic blood pressure (DBP) and slightly lower DBP standard deviation in KTR [20 ▪ ]. In addition, short-term BP variability did not change significantly at 3 and 12 months posttransplant compared to the baseline BP variability 1-month pretransplant [21 ▪ ].…”

Section: Blood Pressure Measurement Modalities In Kidney Transplant R...mentioning

confidence: 93%

A paradigm shift from office to home-based blood pressure measurement approaches in kidney transplant recipients

Tantisattamo,

Ferrey,

Reddy

et al. 2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review The unattended blood pressure (BP) readings from home blood pressure (HBP) monitoring should provide more accurate BP readings than attended BP obtained from office blood pressure (OBP). Here, we review evidence supporting the clinical utility of HBP and automatic remote monitoring of blood pressure (ARM-BP) in kidney transplant recipients (KTR). Recent findings BP from 24-h ambulatory blood pressure monitoring (24-h ABPM) is higher than but better associated with kidney and cardiovascular outcomes compared to OBP and HBP. While there is discordance of BP readings across different BP measurement methods causing BP misclassification, HBP provides BP readings closer to the readings from the 24-h ABPM than those from OBP. Systolic and diastolic BP is better controlled within 30 days after utilizing ARM-BP. Summary Compared to OBP, HBP minimizes the attended effect of OBP, and its readings are closer to the gold standard 24-h ABPM. ARM-BP improves BP control in the short term and trials of longer follow-up duration are required to evaluate sustained clinical benefits in KTR. The paradigm of BP monitoring may shift toward HBP, while OBP may be utilized primarily for KTR who cannot perform HBP for hypertension diagnosis and management.

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Section: Blood Pressure Measurement Modalities In Kidney Transplant R...mentioning

confidence: 93%

A paradigm shift from office to home-based blood pressure measurement approaches in kidney transplant recipients

Tantisattamo,

Ferrey,

Reddy

et al. 2023

Current Opinion in Nephrology &Amp; Hypertension

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Aortic stiffness after living kidney donation: a systematic review and meta-analysis

Rodriguez,

McNeill,

Agharazii

et al. 2024

BMJ Open

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ObjectivesIncreased aortic stiffness measured with carotid-femoral pulse wave velocity (cf-PWV) has been associated with adverse cardiovascular outcomes. Some studies have reported increased cf-PWV in living kidney donors after nephrectomy. This review aimed to determine the effects of living kidney donation on cf-PWV, glomerular filtration rate (GFR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and their differences versus non-nephrectomised healthy individuals.DesignSystematic review and meta-analysis.Data sourcesElectronic databases (MEDLINE, EMBASE, Cochrane Central databases, Cochrane Register of Controlled Trials, Cochrane Methodology Register, Health Technology Database, Technologies in Health, EBM Reviews, ProQuest and ‘Grey Matters Light’). Databases were searched from inception to December 2022.Eligibility criteriaWe searched for studies that measured cf-PWV in living kidney donors before and/or after nephrectomy. Non-nephrectomised healthy individuals included as controls were the comparators. Studies that provided age-adjusted cf-PWV reference values in normotensive healthy individuals were also included.Outcome measuresWe evaluated the mean differences in cf-PWV, GFR and BP before-and-after nephrectomy and their mean differences versus non-nephrectomised healthy comparators. We also explored differences in yearly adjusted cf-PWV changes between donors and normotensive healthy individuals.Data extraction/synthesisTwo independent reviewers extracted data and assessed risk of bias (Risk of Bias tool for non-Randomised studies: ROBINS-I) and quality of evidence (GRADE). Pooled effect estimates were calculated using the inverse variance method and analysed with random effect models.ResultsNine interventional (652 donors; 602 controls) and 6 reference studies (6278 individuals) were included. cf-PWV increased at 1-year postdonation (p=0.03) and was on average 0.4 m/s (95% CI 0.07; 0.60) higher than in healthy controls (p=0.01). These differences were non-significant 5 years postnephrectomy (p=0.54). GFR decreased after nephrectomy (p<0.001) and remained reduced compared with healthy controls (p<0.001), but SBP and DBP were not significantly different (p≥0.14). Yearly changes in cf-PWV postnephrectomy were similar to age-adjusted reference values in healthy normotensive individuals (p=0.76).ConclusionsAortic stiffness increases independent of BP 1 year after kidney donation, but the long-term effects seem minimal. These findings may impact future consent of prospective living kidney donors.PROSPERO registration numberCRD42020185551.

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Visit‐to‐Visit Systolic Blood Pressure Variability Independently Predicts Cardiovascular Events in a Kidney Transplant Recipients' Cohort

Bussalino,

Picciotto,

Macciò

et al. 2024

JAHA

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Background The predictive role of blood pressure variability for all‐cause mortality and fatal and nonfatal cardiovascular events has been described in the general population and in patients with diabetes, independently of mean BP. Although systolic blood pressure variability has been proposed as an informative measure for predicting clinical outcomes in patients with chronic kidney disease, its role in kidney transplant recipients is still debatable. Methods and Results We performed a retrospective, observational, monocentric analysis of all kidney transplant recipients in follow‐up at the outpatient Nephrology Clinic of San Martino Hospital from January 1, 2016 to December 31, 2016, who underwent kidney transplantation >12 months. The primary outcome was a fatal or nonfatal cardiovascular event (myocardial infarction, unstable angina, stroke, and hospitalization for heart failure). Visit‐to‐visit systolic blood pressure variability was expressed as the SD of systolic blood pressure values recorded at baseline and 3 months up to 18 months. Among the 272 patients (mean age, 64±13; 63% men) included in the present analyses, for each increase of 2.7 mm Hg in systolic blood pressure SD, the risk for events increased 3‐fold (hazard ratio [HR], 3.1 [95% CI, 1.19–7.88]; P =0.02), and patients in the highest tertile of systolic blood pressure SD showed a 4‐fold increased risk (HR, 4.1 [95% CI, 1.34–12.43]; P =0.01). This relationship was maintained even after incremental adjustment for time‐averaged pulse pressure, age, diabetes, and prior cardiovascular event (HR, 3.2 [95% CI, 1.1–10.0]; P =0.04). Conclusions Long‐term blood pressure variability represents a risk factor for cardiovascular events in kidney transplant recipients, even independently by several confounding factors including blood pressure load.

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Kidney transplantation and kidney donation do not affect short-term blood pressure variability

Cited by 3 publications

References 44 publications

A paradigm shift from office to home-based blood pressure measurement approaches in kidney transplant recipients

A paradigm shift from office to home-based blood pressure measurement approaches in kidney transplant recipients

Aortic stiffness after living kidney donation: a systematic review and meta-analysis

Visit‐to‐Visit Systolic Blood Pressure Variability Independently Predicts Cardiovascular Events in a Kidney Transplant Recipients' Cohort

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