SAT-324 Study of Ambulatory Blood Pressure Monitoring post kidney donation

Abstract

Hypertension is common in the general population. Uncontrolled hypertension is a contraindication to kidney donation. Issues related to the effect of unilateral nephrectomy leading to increased hypertension on the long term is not well established. Aim of this study is to identify hypertension prevalence in kidney donors by ABPM and study the effect of unilateral nephrectomy on BP in them We prospectively enrolled 80 consenting kidney donors aged between 20 to 65 years and followed them serially at pre donation, 6 month and 12 months post kidney donation. We excluded kidney donors who refused to consent, hypertensives with target organ damage and pregnant females. eGFR is measured using CKD EPI formula. BP was measured in clinic by sphygmomanometer and by Ambulatory Blood pressure monitoring (ABPM) using Meditech ABPM05. 2D Echocardiography, Ophthalmological examination and 24 hour urine protein measurement were done at each visit. There was significant difference ( P < 0.001) in pre-donation Systolic blood pressure by clinic and ABPM ( 138.07 + 5.5 Vs 117.17 + 10.2) suggestive of White coat hypertension( WC) effect of 40% which decreased at 6 months and 12 months. 3.75 patients were having masked hypertension(MH) and only 12.5% donors were having sustained hypertension (SH). No kidney donor had hypertensive retinopathy and Left ventricular hypertrophy ( LVH). Blood pressure was stable by ABPM till 1 year post donation. Obese and elderly (> 50 years) donors had higher observed blood pressure by OBPM and ABPM and low eGFR ( 105 & 99.28 ml respectively ). Mean (Diastolic clinic) BP, systolic - diastolic BP and its day- night component by ABPM was significantly higher in SH and MH groups as compared to WC and Sustained normotensives ( SN). 78.5% of normal dippers were normotensives by ABPM, while 21.5% had hypertension. Baseline pre-donation eGFR measured by CKD-EPI was 108.0+ 12.35 .eGFR decreased at 6 months ( -24%) and 12 months it showed increase of 2% reaching 76 % of the baseline eGFR. There was no significant change in the proteinuria over 1 year post-donation. Hypertension by ABPM at baseline was associated with more decrease in the eGFR at 1 year of follow up with age > 50 years and higher BMI . For prospective kidney donors, ABPM provides a more accurate and reproducible estimate of BP compared to clinic BP to rule out White coat hypertension. Over one year follow up unilateral nephrectomy has no impact on kidney function or proteinuria.