PP.25.11

Abstract

Objective: Hypertension develops early in autosomal dominant polycystic kidney disease (ADPKD) and affects more than a half of patients with end stage renal disease. There are limited data about blood pressure changes in transplanted ADPKD patients and particulary in those who underwent native nephrectomy. Objective: To assess the prevalence of hypertension in transplanted patients with autosomal dominant polycystic kidney disease (ADPKD) and the relationship with pre-transplant native nephrectomy. Design and method: 53 patients after kidney transplantation with ADPKD have been followed-up for 14.5 years. 50 of them were enrolled into the final analysis. Depending on whether native pre-transplant nephrectomy was performed they were divided into three groups: I – no nephrectomy, II – unilateral nephrectomy, III – bilateral nephrectomy. Demographic data and data about time spent on dialysis before transplantation, donor type, graft function, blood pressure, antihypertensive medication, calcineurin inhibitor concentration, glycemia, proteinuria, native kidney size were collected. Results: Group I consisted of 24 patients, group II – 7, group III – 19. No significant differences were found among groups according to demographic characteristics, time spent on dialysis before transplantation, donor type, graft failure, proteinuria, steroid induced diabetes. The hypertension rate before and within 6 months after transplantation was I -70.8% vs 82.6%, II- 71.4% vs 80% and III- 78.9% vs 61.1% respectively. Hypertension after 6 months was more prevalent in I group (95.5%) than in II (40%), III (64.7%) groups (p = 0.008), despite the lower cyclosporine A concentration (p < 0.001). Patient in group I required more antihypertensive medication after kidney transplantation. Prescribing of angiotensin converting inhibitors, sartans and diuretics was also more prevalent in this group. There were 2 cases of steroid induced diabetes in III group, and 1 case in I group. There was no correlation between native kidney size after transplantation and hypertension. Conclusions: We observed that hypertension was more prevalent in patients after kidney transplantation with ADPKD without native nephrectomy compared to those who underwent either unilateral or bilateral nephrectomy.