Influence of Renal Transplantation and Living Kidney Donation on Large Artery Stiffness and Peripheral Vascular Resistance

Abstract

Background Vascular status following renal transplantation (RT) may improve while living kidney donation (LKD) is possibly associated with an increased cardiovascular risk. Methods We prospectively assessed glomerular filtration rate (mGFR, 51Chrome EDTA clearance) and intermediate vascular risk factors in terms of blood pressure (BP), pulse wave velocity (PWV), central augmentation index (AIx), excess pressure (Pexcess), and forearm vascular resistance in donors (n = 58, 45 ± 13 years) and recipients (n = 51, 50 ± 12 years) before and one year following LKD or RT. Results After kidney donation, mGFR decreased by 33% to 65 ± 11 ml/min/1.73m2, while recipients obtained a mGFR of 55 ± 9 ml/min/1.73m.2 Ambulatory 24-hour mean arterial BP (MAP) remained unchanged in donors but decreased by 5 mm Hg in recipients (P < 0.05). Carotid-femoral PWV increased by 0.3 m/s in donors (P < 0.05) but remained unchanged in recipients. AIx was unaltered after LKD but decreased following RT (P < 0.01), and Pexcess did not change in either group. Resting forearm resistance (Rrest), measured by venous occlusion plethysmography, increased after LKD (P < 0.05) but was unaffected by RT, while no changes were seen in minimum resistance (Rmin). ΔPWV showed a positive linear association to Δ24-hour MAP in both groups. Multiple linear regression analysis (adjusting for age, gender, and the baseline value of the studied parameter) did not detect independent effects of graft function on 24-hour MAP, PWV, AIx, vascular resistance, or Pexcess, whereas low post-donation GFR was related to higher AIx and Rrest. Conclusions RT reduced BP and AIx without affecting PWV, whereas LKD resulted in increased PWV and Rrest, despite unchanged BP.

Findings from 4C-T Study demonstrate an increased cardiovascular burden in girls with end stage kidney disease and kidney transplantation

“…PWV increased further after transplantation. In previous studies PWV tended to stabilize or slightly decrease during the first year after kidney transplantation 18,[56][57][58] , but longer observation in adults revealed an increase of PWV 59 . The increase of PWV post-transplantation with time likely reflects an ongoing damage even after transplantation in addition to the "pre-existing" burden from the time pre-KRT.…”

Arterial Mechanics following Living Kidney Donation

“…However, a cross-sectional study of donors evaluated 4-18 years postdonation (mean 9.2 years) showed their pulse wave velocity to be significantly higher than controls (9.562.5 versus 8.561.5 m/s, P,0.001) (9). Differently from the findings in EARNEST, all three previous studies reporting on central BP values did not show any trends of increased aortic BP after donation (4,6,7). Finally, in a previously reported EARNEST substudy using cardiac magnetic resonance imaging, the investigators reported increased left ventricular mass in donors accompanied by an 8% decrease in aortic root distensibility 12 months after donation in 68 donors compared with an 8% increase in 56 healthy controls (10).…”

Prediction of Renal Function in Living Kidney Donors and Recipients of Living Donor Kidneys Using Quantitative Histology

“…The present study is part of a comprehensive project investigating blood pressure (BP) and vascular alterations in LKDs and recipients of living donor kidneys. 18 During a 33-mo period, LKDs and their corresponding recipients were considered for participation. Non–Danish-speaking donors and recipients and foreign donors not likely to be available for study-related follow-up were not asked.…”

“…Twenty-four-hour ambulatory BP measurements were performed with Spacelab Medical 90217BP monitors (Spacelab Healthcare, Issaquah, WA) every 20 min as explained previously. 18 Mean arterial BP was retrieved from the Spacelab output. However, 4 participants (2 donors and 2 recipients) did not have ambulatory recordings at follow-up, and for these, we used unattended office BP, which corresponds to daytime ambulatory BP.…”