Routine Use of Ambulatory Blood Pressure Monitoring in Potential Living Kidney Donors

Ommen, Elizabeth S.; Schröppel, Bernd; Kim, Jin Yon; Gaspard, Gabrielle; Akalin, Enver; Boccardo, Graciella de; Sehgal, Vinita; Lipkowitz, Michael S.; Murphy, Barbara

doi:10.2215/cjn.01240307

Cited by 22 publications

(11 citation statements)

References 27 publications

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“…On the contrary, hypertensive blood pressure readings without confirmation by 24 h blood pressure recording may reflect white coat hypertension. 30 31 In our study, all new diagnoses of hypertension had to be verified by 24 h ambulatory blood pressure recording. Blood pressure values in the normal range were only accepted as ‘normal’ if a list of drugs taken the same day was reported to SOL-DHR.…”

Section: Discussionmentioning

confidence: 99%

Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors

et al. 2016

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ObjectivesTo assess the role of nephrectomy as a risk factor for the development of hypertension and microalbuminuria.DesignProspective, long-term follow-up study.SettingSwiss Organ Living-Donor Health Registry.ParticipantsAll living kidney donors in Switzerland between 1993 and 2009.InterventionsData on health status and renal function before 1 year and biennially after donation were collected.Primary and secondary outcome measuresComparison of 1-year and 5-year occurrences of hypertension among normotensive donors with 1-year and 5-year estimates from the Framingham hypertension risk score. Multivariate random intercept models were used to investigate changes of albumin excretion after donation, correcting for repeated measurements and cofactors such as age, male gender and body mass index.ResultsA total of 1214 donors contributed 3918 data entries with a completed biennial follow-up rate of 74% during a 10-year period. Mean (SD) follow-up of donors was 31.6 months (34.4). Median age at donation was 50.5 years (IQR 42.2–58.8); 806 donors (66.4%) were women. Donation increased the risk of hypertension after 1 year by 3.64 (95% CI 3.52 to 3.76; p<0.001). Those participants remaining normotensive 1 year after donation return to a risk similar to that of the healthy Framingham population. Microalbuminuria before donation was dependent on donor age but not on the presence of hypertension. After nephrectomy, hypertension became the main driver for changes in albumin excretion (OR 1.19; 95% CI 0.13 to 2.25; p=0.03) and donor age had no effect.ConclusionsNephrectomy propagates hypertension and increases susceptibility for the development of hypertension-induced microalbuminuria.

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Section: Discussionmentioning

confidence: 99%

Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors

et al. 2016

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“…A number of studies have noted the value of ABPM when clinic blood pressures are in the hypertensive range among prospective living kidney donors [6]. Such studies have noted that among potential donors who have elevated blood pressure during clinic evaluation, 30–60% of those subjects will be in the normotensive range when studied with ABPM [5,6]. Our study adds to this literature by observing that this white coat effect is not limited to just those with hypertensive clinic blood pressures.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, clinic-based blood pressures do not appear to characterize fully future cardiovascular risk on several fronts [4]. Moreover, limited data suggests a high incidence of white coat hypertension during the kidney donation evaluation [5,6]. However, to our knowledge, no data details the persistence of white coat effect after kidney donation.…”

Section: Introductionmentioning

confidence: 99%

Living Donor Kidney Donation: Another Form of White Coat Effect

2011

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Background/Aims: Living donor nephrectomy can be associated with increases in blood pressure several years following the procedure, but the best method to assess blood pressure during the living donor evaluation process is unclear. Methods: Living kidney donors underwent casual clinic and ambulatory blood pressure monitoring (ABPM) and measurement of central aortic pressures at baseline and 6 months following donor nephrectomy. Results: There was a significant decline in clinic systolic blood pressure (SBP; p = 0.001) and central aortic systolic pressure (p = 0.011) during the study period. However, average ABPM was unchanged and other measures of central arterial pressures and Augmentation Index were unchanged at 6 months compared to baseline. Conclusions: The remarkable differences between clinic SBP and ambulatory SBP prior to donation, and the disappearance of these differences 6 months later, suggest a substantial white coat effect on SBP associated with living kidney donor evaluation. Also, ABPM represents a better way to assess blood pressure prior to kidney donation.

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“…There were no studies in peritoneal dialysis patients, but three studies reported a prevalence between 16% [31] and 39% [32] in renal transplant recipients. There was one study in prospective renal donors reporting a prevalence of 17% [33]. [35].…”

Section: The Effect Of Comorbiditiesmentioning

confidence: 99%