Prospective analysis of the value of 24-hour ambulatory blood pressure on renal function after kidney transplantation

Johannes Jacobi, Jürgen Rockstroh, Stefan John, Matthias Schreiber, Markus P. Schlaich, Hans H. Neumayer, Roland E. Schmieder

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)

Abstract

Background. No prospective study has been performed to determine the prognostic value of 24-hr ambulatory blood pressure (24-hr ABP) versus casual blood pressure (CBP) in patients after kidney transplantation. We have addressed this issue by analyzing renal graft function in patients for the first 5 years after transplantation. Methods. The 24-hr ABP (SpaceLabs 90207) was monitored 6 and 18 months after transplantation in 46 renal transplant recipients without any acute episodes of rejection. Combined study endpoints were death of patients, need for dialysis, second transplantation, and doubling of serum creatinine. Results. Six months after transplantation systolic and diastolic 24-hr ABP correlated with serum creatinine (r=0.41, P=0.005 and r=0.37, P<0.01, respectively) although CBP did not. Divided into tertiles according to average 24-hr ABP (lower tertile: ≤91 mmHg; middle tertile: 92-97 mmHg; upper fertile: ≥98 mmHg) serum creatinine significantly differed between the three groups (1.26±0.38 vs. 1.32±0.25 vs. 1.65±0.39 mg/dl, respectively; analysis of variance, P<0.01). Confounding factors of renal function such as age, body weight, cold and warm ischemic time, cytomegaly virus status, methylprednisone and cyclosporine dosages, cyclosporine concentrations, as well as concomitant antihypertensive medication did not differ among the three groups. In the long-term follow-up (5 years), combined endpoints were reached in 3 of 15 of the lower tertile group, in 3 of 15 of the median fertile group, and in 8 of 16 of the upper tertile group (log-rank test, P<0.01). No relation to long-term outcome was found when patients were stratified according to their CBP. Conclusion. In our small but homogenous study cohort 24-hr ABP was more closely related to renal function in patients after transplantation than CBP suggesting that 24-hr ABP is superior for evaluation of hypertension-related renal graft dysfunction.

Original languageEnglish
Pages (from-to)819-827
Number of pages9
JournalTransplantation
Volume70
Issue number5
DOIs
Publication statusPublished - 15 Sept 2000
Externally publishedYes

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