Kidney Transplantation Outcomes of Patients With Chronic Hypotension in Dialysis

Abstract

IntroductionPersistent chronic hypotension affects 5-10% of dialysis patients. It seems to be reversible after receiving a functioning graft, but data regarding its influence on transplant outcomes are scarce. We analyse the evolution of patients with chronic hypotension in dialysis who undergo kidney transplantation at our center. MethodsA retrospective observational study was conducted. Sixty-six patients with chronic hypotension (defined as systolic blood pressure ≤ 100 mmHg at the time of transplantation) were identified. A control group of 66 non-hypotensive patients was assigned and matched for organ source and age. The evolution of both groups was compared. ResultsHypotensive patients had higher rates of primary non-function (18.2% vs 6.1%, p= 0.03) mainly due to venous thrombosis of the allograft (15.2% vs 3%, p= 0.015), worse renal function at the end of follow-up (eGFR of 35mL/min/1.73m2 vs 48mL/min/1.73m2, p= 0.001) but there was no statistical difference in graft survival after censoring for primary non-function. After multivariable adjustment, chronic hypotension remained an independent predictor factor for kidney graft failure (adjusted HR of 2.85; 95% CI: 1.24-6.57; p= 0.014). Use of vasoactive drugs and anticoagulation in hypotensive patients was associated with 7.1% of venous graft thrombosis compared to 17.3% in those with no intervention (p= 0.68). Receiving a functioning graft implied blood pressure normalization in patients with chronic hypotension. ConclusionsChronic hypotension in dialysis has a negative impact on short-term kidney transplant outcomes but a lower impact on long-term results. It is reversible after receiving a functioning graft. Identifying this subgroup of patients seems crucial to implement measures aimed at improving transplant results.