Arterial Hypertension and Renal Allograft Survival

Mange, Kevin C.; Čižman, Borut; Joffe, Marshall M.; Feldman, Harold I.

doi:10.1001/jama.283.5.633

Cited by 260 publications

(172 citation statements)

References 20 publications

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“…In this group of patients, it may be very difficult to add additional medication to achieve treatment goals. Given the beneficial effects of blood pressure control in transplant recipients (19,20), further research aimed at improving care in this area is needed.…”

Section: Discussionmentioning

confidence: 99%

The Burden of Chronic Kidney Disease in Renal Transplant Recipients

Karthikeyan

Karpinski

Nair

et al. 2004

American Journal of Transplantation

134

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The National Kidney Foundation has developed guidelines for the diagnosis and classification of chronic kidney disease (CKD) but it is not known whether these are applicable to renal transplant recipients. This study determined the prevalence of CKD according to the stages defined in the guidelines, the complications related to CKD and whether the prevalence of complications was related to CKD stage in 459 renal transplant recipients. CKD was present in 412 patients (90%) and

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Section: Discussionmentioning

confidence: 99%

The Burden of Chronic Kidney Disease in Renal Transplant Recipients

Karthikeyan

Karpinski

Nair

et al. 2004

American Journal of Transplantation

134

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“…In addition, hypertension validated even at 1-year post-transplant serves as a significant predictor of long-term renal allograft survival, independent of baseline renal allograft function. 5 Moreover, hypertension predicted the risk of acute rejection and higher levels of BP preceded episodes of acute rejection in one study. 6 Thus, hypertension appears to have an important role in graft events and graft outcomes.…”

Section: Introductionmentioning

confidence: 96%

Blood pressure control in kidney transplantation: therapeutic implications

et al. 2004

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Post-transplant hypertension remains a significant risk factor for graft loss, but whether or not specific blood pressure (BP) medications affect graft outcome is still unknown. We assessed the interaction between BP control and antihypertensive drugs on graft outcome. We retrospectively examined clinic BP data for 1662 renal transplant (RTx) patients, transplanted between 1994 and 2000 at our centre. The analysis examined all patients who received central a-agonists and peripheral a-antagonists, beta-blockers, calcium channel blockers (CCBs), angiotensin-converting enzyme (ACE) inhibition (ACEI), angiotensin receptor blockers (ARBs). BP recordings during treatment were categorized for each agent. Thus, a particular BP could be categorized for multiple medications. A total of 1462 patients (pts) (88%) were Caucasian and 800 pts (46%) received cadaveric RTx. There were 10.676.8 BP measurements for each patient post-RTx. CCBs, alone among the classes of antihypertensive drugs evaluated, reduced the risk for graft loss (RR: 0.736; P ¼ 0.035) in the overall analysis. Interestingly, stratifying levels of BP control unmasked a beneficial effect on graft survival of ACEI/ ARB therapy in individuals with higher levels of systolic (4152 mmHg) and diastolic blood pressure (498 mmHg) treated with ACEI/ARBs compared to individuals treated with CCBs (Po0.01 for each). Thus, stabilizing BP is important post-RTx. CCBs are associated with improved rates of graft survival. Their role in a compromised RTx, however, deserves further study. ACEI/ARBs have clear benefits, improving graft survival in individuals with elevated systolic blood pressure and proteinuria. CCBs are not as efficacious in this setting.

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“…Loss of circadian BP changes has been linked to target organ damage and accelerated kidney function loss in hypertensive patients with and without CKD (9,33,34). Although uncontrolled systemic hypertension is related to poor allograft and patient survival after kidney transplantation, loss of normal nocturnal fall in SBP, independent of BP control, has not been fully defined as a promoter of kidney function attrition after transplantation (2,35,36). Haydar et al (37) studied the role of ABPM-derived BP values that were obtained at 2 to 34 wk after transplantation in predicting renal function decline in 177 kidney transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

“…Iothalamate clearance correlated with the percentage of nocturnal fall in SBP (R ϭ 0.3, P ϭ 0.003). For every 10% nocturnal drop from the awake average SBP, GFR increased by 4.6 ml/min per 1.73 m 2 .…”

Section: Relationship Between Circadian Bp Change and 1-yr Gfrmentioning

confidence: 92%

Diurnal Blood Pressure Changes One Year after Kidney Transplantation

Wadei

Amer

Taler

et al. 2007

Journal of the American Society of Nephrology

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Loss of circadian BP change has been linked to target organ damage and accelerated kidney function loss in hypertensive patients with and without chronic kidney disease. Ambulatory BP-derived data from 119 consecutive kidney transplant recipients who presented for the first annual evaluation were examined in relation to allograft function, histology, and ultrasound findings. A total of 101 (85%) patients were receiving antihypertensive medications (median 2), and 85 (71%) achieved target awake average systolic BP (SBP) of <135 mmHg. A day-night change in SBP by 10% or more (dippers) was detected in 29 (24%). Dipping status was associated with younger recipient age, lack of diabetes, low chronic vascular score, and low resistive index. Nondippers and reverse dippers had lower GFR compared with dippers (P ‫؍‬ 0.04). For every 10% nocturnal drop in SBP, GFR increased by 4.6 ml/min per 1.73 m 2 (R ‫؍‬ 0.3, P ‫؍‬ 0.003). Nondippers and reverse dippers were equally common in recipients with normal histology and in those with pathologic findings on surveillance biopsy. On multivariate analysis, percentage of nocturnal fall in SBP and elevated resistive index independently correlated with GFR. This study indicates that lack of nocturnal fall in SBP is related to poor allograft function, high chronic vascular score, and high resistive index irrespective of allograft fibrosis. Further studies are needed to determine whether restoration of normal BP pattern will confer better allograft outcome.

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Arterial Hypertension and Renal Allograft Survival

Abstract: Systolic, diastolic, and mean arterial blood pressures at 1 year posttransplantation strongly predict allograft survival adjusted for baseline renal function. More aggressive control of blood pressure may prolong cadaveric allograft survival.

Cited by 260 publications

References 20 publications

The Burden of Chronic Kidney Disease in Renal Transplant Recipients

The Burden of Chronic Kidney Disease in Renal Transplant Recipients

Blood pressure control in kidney transplantation: therapeutic implications

Diurnal Blood Pressure Changes One Year after Kidney Transplantation

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