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.
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