MO087: Ambulatory Blood Pressure Trajectories and Blood Pressure Variability in Kidney Transplant Recipients: A Comparative Study Against Hemodialysis Patients

Abstract

Abstract BACKGROUND AND AIMS Hypertension is the most prevalent cardiovascular risk factor in kidney transplant recipients (KTRs). Preliminary data suggest similar ambulatory blood pressure (ΒP) levels in KTRs and hemodialysis (HD) patients. This is the first study evaluating in comparison the full ambulatory BP profile and short-term BP variability (BPV) in KTRs versus HD patients. METHOD Two hundred four KTRs were matched (2:1 ratio) with 102 HD patients for age and gender. BP levels, BP trajectories and BPV indices over a 24-h ambulatory BP monitoring (ABPM) in KTRs were compared against both the first and second 24-h period of a standard 48-h ABPM in HD. To evaluate the effect of renal replacement treatment and time on ambulatory BP levels, two-way-ANOVA for repeated-measurements was performed. RESULTS KTRs had significantly lower SBP and pulse-pressure (PP) levels compared with HD during all periods studied (24-h SBP: KTR: 126.5 ± 12.1 mmHg; HD first 24-h: 132.0 ± 18.1 mmHg, P = 0.006; second 24-h: 134.3 ± 17.7 mmHg, P < 0.001); no significant differences were noted for DBP levels with the exception of second nighttime. Repeated-measurements-ANOVA showed a significant effect of RRT modality and time on ambulatory SBP levels during all periods studied, and a significant interaction between-them; the greatest between-group difference in BP (KTRs—HD in mmHg) was observed at the end of the second 24-h (−13.9 mmHg, 95%CI: −21.5 to −6.2, P < 0.001). Ambulatory systolic and diastolic BPV indices were significantly lower in KTRs than in HD during all periods studied (24-h SBP-ARV: KTRs: 9.6 ± 2.3 mmHg; HD first 24-h: 10.3 ± 3.0 mmHg, P = 0.032; second 24-h: 11.5 ± 3.0 mmHg, P < 0.001). No differences were noted in dipping pattern between the two groups. CONCLUSION SBP and PP levels and trajectories, and BPV were significantly lower in KTRs compared to age- and gender-matched HD patients during all periods studied. These findings suggest a more favorable ambulatory BP profile in KTRs, in contrast with previous observations.