Background: Visit-to-visit blood pressure variability (VVBPV) results from regional or systemic circulatory factors such as stiffness or neuro-hormonal factors. Association between VVBPV and long-term post-kidney transplant (KT) blood pressure (BP) is unknown. Method: VVBPV was measured by average successive variability (ASV), which is the average absolute difference between successive BP measured at 4, 12, and 24 weeks post-KT. Association between the VVBPV and BP at 48 weeks post-KT was examined by multiple linear regression. Results: Of all 105 KT recipients, mean age±SD was 54±12 years and 64 patients (61%) was female. Mean ASV of SBP and DBP were 16±12 mmHg (range 1-58) and 11±6.3 mmHg (range 1-29.5), respectively. Mean SBP at 24 and 48 weeks post-KT were 135±19 and 133±16 mmHg, respectively. Similar to SBP, mean DBP at 24 weeks post-KT was higher than DBP at 48 weeks (DBP 24 vs 48 weeks 80±12 vs 77±11 mmHg). Every 10-mmHg increase in ASV of SBP predicts 3.4 mmHg increase in SBP at 48 weeks post-KT (p 0.01; 95%CI 0.83, 6.14; Figure 1A). However, an increase in 10 mmHg of ASV of DBP predicts a decrease in DBP of 0.12 mmHg (p 0.12, 95%CI -0.28, 0.04; Figure 1B). After adjusted for age, gender, donor type (deceased vs living), induction immunosuppressive medications, pre-KT weight-spline interaction term at 70 kg, every 10 mmHg increase in ASV of SBP was significantly associated with 2.7 mmHg increase in SBP at 48 weeks post-KT (p 0.04, 95%CI 0.15, 5.29); whereas, 10 mmHg increase in ASV of DBP predicts a decrease in DBP of 2.13 mmHg with no statistical significance (p 0.16, 95% -5.14, 0.88) Conclusion: Higher VVSBPV during early post-KT predicts a higher SBP, but not DBP, at late post-KT period.
Mayo classification 1C, 1D, or 1E or kidney length from ultrasonography of >16.5 cm' (iv) PKD1 truncated mutation with early symptoms (PRO-PKD score >6). All other patients without any of the criteria are classified as slow progression. The clinical characteristics will be compared between patients with rapid progression and slow progression. In addition, the incidence rate, age of diagnosis, treatment complications between patients with rapid and slow progression will be analyzed. The clinical characteristic differences according to age groups will be analyzed as secondary analysis. The planned sample size of the cohort is 2,000 patients, and as October 8 th 2018, data from 280 patients have been collected. Conclusions: RAPID-ADPKD is the first large-scale multinational retrospective observational study of ADPKD in Asia-Pacific region and will identify the clinical characteristics, risk factors for disease progression and patterns of complications in Asian populations with ADPKD.
IntroductionObesity is associated with hypertension (HTN). Recent new diagnostic criteria for HTN with systolic blood pressure (SBP) and diastolic blood pressure of >130 and >80 mmHg, respectively associated with body mass index (BMI) in kidney transplant recipients is unknown.MethodsSystolic hypertension (SHTN) and diastolic hypertension (DHTN) after 1‐month post‐transplantation is determined by old and new diagnostic criteria. A time‐to‐events of developing post‐transplant SHTN and DHTN associated with pre‐transplant BMI are compared between HTN defined by old and new criteria by using Cox proportional hazard regression analysis.ResultsSeventy kidney transplant recipients are reviewed and followed for 96 months. Mean age was 52.7±1.4 years (mean±SEM) and 59% are males. Half of the study population is White, and 34% and 16% are Black and others, respectively. Mean pre‐transplant BMI is 27.64±0.67 kg/m2. At 1‐month post‐transplant, a mean pre‐transplant SBP and DBP are 130.91±2.14 and 77.71±1.51 mmHg, respectively. With an old diagnostic criterion for HTN, 70% have SHTN but up to 90% have SHTN diagnosed by the new criteria. At 96‐month post‐transplant, obese patients has 15% lower risk for SHTN diagnosed with the old criterion (Hazard ratio (HR) 0.850; 95% CI 0.473 – 1.529; p‐value 0.588); whereas, these patients have 2.3% greater risk for SHTN by new criteria (HR 1.023; 95% CI 0.601 – 1.741; p‐value 0.934) [figure 1]. For DHTN, obese patients have 23.7% decreased risk for DHTN diagnosed with the old criterion (HR 0.763; 95% CI 0.394 – 1.478; p‐value 0.422), and also have 14.9% lower risk for DHTN by new criteria (HR 0.851; 95% CI 0.496 – 1.461; p‐value 0.559) [figure 2].ConclusionThe incidence of SHTN and DHTN are increased with the new diagnostic criterion for HTN. The new criteria appear to have the reverse effect on the association between BMI and SHTN, but not DHTN. Further studies related to SHTN are required to elucidate the outcomes of SHTN after kidney transplantation.Support or Funding InformationNoneThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Introduction: Wide pulse pressure (PP) is common in elderly and associated with poor cardiovascular outcomes. Association between PP and long-term hypertension (HTN) in kidney transplant recipients (KTR) among different age groups is unclear. Hypothesis: We hypothesize that PP at early post-kidney transplant (KT) predicts different long-term post-KT HTN among different age groups. Methods: This is a retrospective cohort study of consecutive KT recipient in a single center. With age categorized into < and ≥ 50 years old, association between PP at 4 and 12 weeks post-KT (when a baseline kidney allograft function is generally established) and post-KT systolic and diastolic HTN (SHTN and DHTN) at a 48-week post-KT defined by SBP and DBP ≥ 130 and 80 mmHg, respectively were examined by using multiple logistic regression. Results: Of all 105 KTR, 40 and 65 patients were <50 and 65 years old, respectively. Mean age±SD was 54±12 years with a median follow-up of 47.71 weeks. At a 4-week post-KT, mean PP was 54±13 mmHg with a mean difference young - old ±SE of -7±3 (p 0.011; 95%CI -11.55, -1.53). Mean PP at a 12-week post-KT was 56±16 mmHg and a mean difference±SE of -8±3 mmHg (p 0.018; 95%CI -13.95, -1.35). At 48-week post-KT, 50% of the young had SHTN 66% of the old had SHTN; whereas, 58% and 38% of the corresponding groups had DHTN. Mean SBP of the young and old groups were 129±16 and 135±16 mmHg, respectively (mean difference -6±3; p 0.076; 95%CI -12.66, 0.63). Mean DBP of the corresponding groups were 80±12 and 75± 10 with a mean difference 5±2; p 0.036; 95%CI 0.332, 9.394). After adjusted for pre-KT BMI, type of KT, and induction immunosuppression, every 1 mmHg increase in PP at the 4-week post-KT was associated with 6% greater the odds of developing SHTN at 48-week post-KT among the older age group (OR 1.06; p 0.041, 95%CI 1.002, 1.117); whereas, the risk was 2% increase in younger group (OR 1.02; p 0.400; 95%CI 0.969, 1.082). The association between PP at the 12-week post-KT and SHTN at 48-week post-KT were in the same direction, but it was attenuated (5%) in the older and strengthen the younger (7%) (OR old 1.048; p 0.033; 95%CI 1.004, 1.095 and OR young 1.087; p 0.050; 95%CI 1.000, 1.1801). There were no association between PP at 4- and 12-week post-KT and DHTN at 48-week post-KT. Conclusion: Higher early post-KT PP was associated with increased risk of long-term post-KT SHTN, but not DHTN. However, the magnitude of the association was greater among the older KTR at early post-KT, but higher in the younger at later post-KT period. Mechanism of increased PP and outcomes such as post-KT HTN in KTR needs to be further elucidated.
Robot assisted kidney transplantation , being a minimally invasive procedure, is said to offer certain advantages to the recipient : quicker recovery time, less blood loss, less wound infections, less post operative pain, and better cosmesis , when compared to open surgery. Aim of the study: To compare our experience of Robot assisted kidney transplantation (RAKT) with open kidney transplantation (OKT) surgery done by the same surgeon. Methods: Study of all robot assisted kidney transplantations (RAKTgroup 1) done by a surgeon experienced in laparoscopic and robot assisted surgeries, from January 2015 to October 2018 in adult recipients (age above 18 years). Clinical data, outcomes and complications were analysed; this data was compared to recipients who underwent open kidney transplantation surgery (OKT-group 2) by the same surgeon during the same period. The donors were either first degree relatives (80%) or spouses (20%). The graft was positioned extraperitoneally. Both groups received identical immunosuppression according to our protocol-Tacrolimus (initial dose of 0.1mg/kg/day) to maintain trough levels of 6 to 12 ng/ml in the first three months and subsequently 3 to 6ng/ml, Mycophenolate Mofetil (35mg/kg/day) and Prednisolone (0.5mg/kg/day initially , tapering to 0.125mg per day by 3 months). Total surgery time, cold ischemia time, blood loss, postoperative pain score by visual analogue scale, delayed graft function, reexploration rate, incidence of urinary tract & wound infections, length of hospital stay, length of surgical scar , and graft function in the two groups were studied. Statistical analysis was done using Students T test, Chi-Square test and Mann-whitney test.
We discuss the use of urine electrolytes and urine osmolality in the clinical diagnosis of patients with fluid, electrolytes, and acid-base disorders, emphasizing their physiological basis, their utility, and the caveats and limitations in their use. While our focus is on information obtained from measurements in the urine, clinical diagnosis in these patients must integrate information obtained from the history, the physical examination, and other laboratory data.
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