Pathomechanisms and the diagnosis of arterial hypertension in pediatric renal allograft recipients

Vester, Udo; Wingen, Anne–Margret; Hoyer, Peter F.

doi:10.1007/s00467-004-1601-2

Cited by 38 publications

(41 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As in adults, there is widespread consensus on the importance of achieving BP control in hypertensive paediatric recipients [14,15]. On the other hand, guidelines for the treatment of post-transplant hyperlipidemia in paediatric recipients are not available so far [16].…”

Section: Introductionmentioning

confidence: 99%

Potential cardiovascular risk factors in paediatric renal transplant recipients

et al. 2005

View full text Add to dashboard Cite

Cyclosporin (CsA) therapy is associated with side effects such as hypertension, hyperlipidemia and nephrotoxicity. Tacrolimus (Tac) has been shown to be more favourable in this respect. We retrospectively analysed office blood pressure (BP), serum total cholesterol (TC) and fasting glucose levels, and estimated graft function profiles in paediatric (n =56) and young adult (n =14) renal transplant recipients whose maintenance immunosuppressive regimen was based upon CsA (n =38) or Tac (n =32) given with mycophenolate mofetil and corticosteroids. The analysis was performed at four different time-points: at 1, 6, 12, and 24 months post-transplant, respectively. Baseline characteristics were comparable between treatment groups. Differences for both systolic and diastolic BP, and graft function between treatment groups became significant from month 1 and throughout the 2-year period. Values (mean +/- SD) for CsA-treated and Tac-treated recipients at 2 years were 118.8+/-11.1 / 74.6+/-7.4 mmHg vs 109.3+/-11.2 / 67.2+/-7.8 mmHg for systolic and diastolic BP, respectively, p <0.005/0.005; and 72.0+/-18.5 ml/min vs 84.0+/-22.4 ml/min per 1.73 m(2) for graft function, respectively, p <0.01. Office hypertension, defined as the use of antihypertensive medication at month 24, was significantly associated with CsA-therapy (chi(2), p <0.01). TC levels became significantly lower at months 6, 12, and 24 in the Tac group compared with the CsA group. Hypercholesterolemia, defined as TC>or=200 mg/dl, was significantly associated with CsA-based immunosuppressive regimen at months 6, 12, and 24 post-transplant (chi(2), p <0.05, p <0.001, and p <0.01, respectively). Although Tac therapy was associated with higher glucose levels, no recipient developed post-transplant diabetes mellitus. The number of recipients who experienced acute rejections was comparable in both groups. In conclusion, Tac-based immunosuppressive therapy was found to be associated with more favourable potential risk-factor profiles for cardiovascular disease and better graft function at 2 years post-transplant compared with CsA-therapy.

show abstract

Section: Introductionmentioning

confidence: 99%

Potential cardiovascular risk factors in paediatric renal transplant recipients

et al. 2005

View full text Add to dashboard Cite

show abstract

“…It is linked to an increased risk of cardiovascular events, graft failure, proteinuria, and death [2,3]. Post-transplant hypertension is a multifactorial phenomenon and the known causes of hypertension include immunosuppressive drugs, renal graft artery stenosis, recipient's native kidney, allograft dysfunction, obesity, recurrent or de novo renal disease, and genetic factors [4].…”

Section: Introductionmentioning

confidence: 99%

Blood pressure profile in renal transplant recipients and its relation to diastolic function: tissue Doppler echocardiographic study

et al. 2011

View full text Add to dashboard Cite

Hypertension is a common complication after renal transplantation and is associated with increased risk of cardiovascular disease. The aim of the current study was to investigate the diurnal blood pressure pattern and its relation to structural and functional cardiac changes in renal transplant recipients. Sixty-six stable renal transplant patients (34 female, 32 male), aged 7 to 25 years (mean 17.4±4.3 years) were enrolled in this study. Cardiac function assessed by tissue Doppler echocardiography and blood pressure measurement performed using both the ambulatory and the casual method. Hypertension was demonstrated in 57% of recipients by the casual method and in 75.7% by ambulatory blood pressure monitoring (ABPM). The efficacy of BP control among patients on antihypertensive drugs was 60%. The prevalence of non-dipping was 73%. There was significant inverse correlation between systolic or diastolic day-time or night-time BP index and post-transplant duration (p<0.001, r=-0.386), but no correlation between ABP parameters and BMI, gender, and eGFR. There was a significant relationship between all ABP parameters and left ventricular mass index (LVMI) (p=0.025-0.007, r=0.28-0.38). LVMI was significantly higher in hypertensive than in normotensive cases (p=0.034). There was no difference in diastolic function between hypertensive and normotensive patients or between patients with and without left ventricular hypertrophy (LVH). In conclusion, our study showed the advantage of ABPM over the casual method of diagnosis of hypertension. LVH is common in transplant patients and is likely associated with arterial hypertension. Hypertension and LVH cannot differentiate transplant patients with diastolic malfunction.

show abstract

“…13,14,16,18,19,21,22,[24][25][26] Comprehensive nonsystematic reviews advocate that a major barrier to overall BP control in this population is largely because office BP measurements do not mirror the recipient's true BP and, therefore, recommend the use of ABPM following renal transplantation. 3,4,27 However, there are no available data on whether the routine use of ABPM would improve identification of true hypertensive recipients and result in better BP control. We infer that this clinical goal might in fact be achieved by applying ABPM at regular intervals following renal transplantation.…”

mentioning

confidence: 97%

“…1,2 In addition, pediatric recipients exposed to a long duration of hypertension are more likely to die in early adult life than recipients exposed to a relatively short period of hypertension. 1 Because postrenal transplant hypertension is a widespread condition in pediatric allografts, 3,4 the ultimate goals in this high-risk population are proper and early identification of true hypertensive recipients and achievement of an adequate and sustained blood pressure (BP) control.…”

mentioning

confidence: 99%