Predonation Blood Pressure Research Articles

Abstract 4137883: Association of Pre-Donation Blood Pressure with Hypertension in Living Kidney Donors

Background: Living kidney donors (LKD) are at risk for developing hypertension (HTN); however, the levels of pre-donation blood pressure (BP) that may predict post-donation BP are unknown. Hypothesis: Higher pre-donation BP is associated with a greater risk of developing post-donation HTN. Goals: We aim to examine the association between pre-donation BP and the risk of developing HTN in LKD. Methods: A retrospective cohort study using OPTN/SRTR included adult LKD undergoing donation between 6/1972 and 9/2022. Systolic and diastolic hypertension (SHTN and DHTN) were defined by SBP ≥130 and DBP ≥80 mmHg, respectively. Multiple Cox regression was utilized to examine the association between decile of pre-donation BP and time-to-event of developing post-donation SHTN and DHTN. Results: Of 174,311 adult LKD, the mean±SD age was 41±12 years and 60% were female. Mean pre- and post-donation SBP and DBP and deciles of BP are shown in Table 1 and Figure 1, respectively. The median time to follow-up for developing SHTN was 13.2 (IQR 6.8, 24.4) and DHTN was 12.2 months (IQR 6.3, 24.1). The incidence rate of developing SHTN and DHTN was 0.020 and 0.03 person-months, respectively. After adjusting for age (<65 vs. ≥65 y/o), gender, race, U.S. citizenship, education level, history of pre-donation HTN, diabetes, pre-donation BMI, DBP, eGFR, urine protein:creatinine ratio, and the interaction term between decile of pre-donation SBP and age, LKD in deciles 5 to 10 (SBP 119–200 mmHg) had significantly graded increased risk for developing SHTN compared to LKD in decile 4 (SBP 115-118 mmHg; HR decile10 4.82, 95%CI 3.37, 6.91), while those in deciles 1 to 3 had a graded decrease in the risk but were non-significant (HR decile1 0.68, 95CI% 0.42, 1.11). In addition, there was a decreased risk of SHTN observed in elderly LKD (≥65 y/o) in deciles 5 and 10 (P interaction 0.041 and 0.009). The pattern of pre-donation DBP decile – DHTN association was similar to the SBP – SHTN association, but only DBP deciles 8-10 (DBP 81–195 mmHg) were significant (HR decile10 2.10, 95%CI 1.31, 3.34); Figur 2. There was no interaction between pre-donation DBP and age. Conclusions: Elevated pre-donation SBP or DBP greater than 118 or 80 mmHg is associated with a graded increase in developing post-donation SHTN or DHTN, respectively especially in the non-elderly (<65 years old) LKD. BP control during the pre-donation period should be achieved to mitigate the risk of post-donation HTN.

Abstract P339: Association of Pre-Donation Blood Pressure with Kidney Function in Living Kidney Donors

Background: Although BP is associated with kidney outcomes, its clinical significance in living kidney donors (LKD) is unknown. We aim to examine the association between pre-donation BP and the risk of kidney function decline in LKD. Methods: A retrospective cohort study using OPTN/SRTR including adult LKD, who underwent donation between 6/1972 and 9/2022, was utilized to examine the association of quartile (Q) of pre-donation SBP and DBP with time-to-event of ≥35% decline in post-donation eGFR from pre-donation eGFR by multiple Cox regression. Results: Of 174,311 adult LKD, mean±SD age was 41±12 years and 60% were female. Mean pre-donation SBP and DBP were 122±13 and 74±9 mmHg, respectively. Mean pre-donation SBP in Q 1, 2, 3, and 4 were 106±6, 117±2, 126±3, and 140±9 mmHg, respectively and the corresponding DBP were 62±5, 71±2, 78±2, and 86±5 mmHg, respectively. The median (IQR) of pre-donation eGFR was 91 (75, 111) mL/min/1.73 m 2 . Median(IQR) eGFR at immediate post-donation, 6-, 12-, and 24-months post-donation were 50 (40, 62), 54 (44, 67), 55 (45, 68), and 57 (47, 70) mL/min/1.73 m 2 , respectively. Out of 38,780 LKD with post-donation eGFR data at 6, 12, or 24 months, 31,054 had the event of ≥35% decline in post-donation eGFR from pre-donation eGFR with a median time to follow-up of 6.77 months(IQR 5.93, 12.67). The incidence rate of the event was 0.08 person-months. Compared to patients with SBP in Q 1, those with SBP in Q 2, 3, and 4 had a significantly increased risk for the event(HR SBP Q2,3,4 1.05, 1.08, and 1.15; P <0.001 – 0.003) but only patients with DBP in Q 3 and 4 had a significantly increased risk for the event (HR SBP Q3,4 1.04 and 1.09). After adjusting for age, gender, race/ethnicity, U.S. citizenship, education level, history of pre-donation HTN, diabetes, pre-donation BMI, DBP, and urine protein:creatinine ratio, there was a J-shaped association between pre-donation SBP and post-donation eGFR decline and only patients in the Q 2 became significantly associated with lower the risk for the event (HR 0.87, 95%CI 0.76, 0.99; Fig1). The pre-donation DBP – post-donation eGFR association was similar to the SBP – eGFR association but there was no statistically significant in all Q (Fig2). There was no effect-measured modifier for all covariates. Conclusions: Pre-donation SBP in a normal range(113 - 120 mmHg) is associated with the lowest risk for a post-donation eGFR decline. BP control in the normal range should be achieved for potential LKD.

A Cross-Sectional Study of Blood Donors’ Psychological Characteristics over 8 Weeks

Background: Previous studies suggest that blood donation impacts blood donors’ psychological state, with either positive or negative effects, such as feeling more energetic or more exhausted. It has not yet been described how long these effects last. Materials and Methods: This prospective cohort study consisted of a qualitative and a quantitative part: (1) Psychological characteristics which changed after blood donation were identified by structured interviews of regular whole blood donors (n = 42). Based on this, a questionnaire addressing 7 psychological dimensions was established. (2) The psychological state of 100 blood donors was assessed after blood donation by applying the questionnaire 15–30 min before and during donation, as well as 15–30 min, 6 h, 24 h, 72 h, 1 week, and 8 weeks after donation. The resulting changes were summarized to a score. Furthermore, potential correlations of the score with pre-donation blood pressure, hemoglobin, or body mass index were calculated. Results: Seven items were identified which changed in at least 25% of blood donors (mood, concentration, satisfaction, resilience, spirit of initiative, physical well-being, energy level). In the 100 blood donors, the well-being score increased (positive effects, n = 23), showed minor changes (n = 53), or decreased (negative effects, n = 24). The positive effects lasted for about 1 week and the negative effects for 3 days. Conclusion: While the frequency of psychological effects following blood donation identified by our study was comparable to others, the changes of the psychological state in our donors were traceable for a longer period than previously acknowledged.

Evaluation of pre-donation anxiety and attitude of blood donors and its effect on blood pressure and pulse rate

Background: Previous negative experiences (NEs) during the process of blood donation can resultin increased stress and is indicated by blood pressure and pulse rate, at a subsequent donation. Thepresent study investigated the effect of attitude and anxiety in 1st time and regular blood donorswith or without any previous NE on the pre-donation blood pressure and pulse rate. Materials andmethods: Pre-donation blood pressure and pulse rate in 1st time and regular donors weremeasured. The attitude and anxiety were evaluated using a questionnaire and the relationship with aprevious NE was assessed. Its effect on the blood pressure and pulse rate was subsequentlyevaluated. The study was a between-subjects, observational design. Results: Of the total 200donors, 165 were males. 54 donors showed signs of anxiety whereas 33 donors had a previous NE.11 donors (22.44%) who had a previous negative experience showed raised blood pressure whereas9 donors (18.36%) with a previous negative experience showed a raised pulse rate. Both effective(-0.293) and cognitive (-0.0159) attitudes were negatively correlated with anxiety and were foundto be statistically significant. Conclusion: No significant association was seen in a donor whoexperienced a negative experience in a previous visit with raised pre-donation blood pressurehowever, was significantly associated with a raised pulse rate. Moreover, anxiety and increased bloodpressure, and increased pulse rate were assessed in first-time donors and it was seen that first-timedonors especially showed raised blood pressure and pulse rate.

Vasovagal reaction among whole blood donors in Hospital Pulau Pinang. A statistical-epidemiological study

CONTEXT:Whole blood donation is generally considered a safe procedure; however, a small percentage of donors could develop vasovagal reactions (VVRs) during or after completion of blood donation.AIMS:This study was undertaken to establish the prevalence of VVR among whole blood donors in Hospital Pulau Pinang and to investigate factors that lead to its occurrence.SETTINGS AND DESIGN:A cross-sectional study was conducted involving 27,890 whole blood donations in 2016.SUBJECTS AND METHODS:For each donation, donor's demographic and blood donation-related information was extracted from the blood bank database.STATISTICAL ANALYSIS USED:Qualitative data including age group, sex, race, frequency, and location of donation were analyzed using Chi-square tests, while blood pressure was analyzed using t-test.RESULTS:Overall, 425 cases of VVRs were reported, resulting in a VVR rate of 1.5% (one event in every 65 donations). We found a statistically significant association (P < 0.05) between the occurrence of VVRs with the young age group, female gender, Indian race, first-time donor, lower predonation blood pressure, and donation performed in a mobile donation campaign. The most common vasovagal symptoms are lightheadedness (88%), followed by nausea (5.4%), muscle twitching (3.5%), vomiting (1.4%), loss of consciousness <30 s (1.4%), and paresthesia (0.2%).CONCLUSIONS:The prevalence of VVRs among whole blood donors in Hospital Pulau Pinang appeared to be low. Our study reaffirms that blood donation is a relatively safe process, and the incidence of VVR can be further reduced by ensuring strict screening procedure before blood donation.

Effect of a liberal versus a restrictive pre-donation blood pressure policy on whole-blood donor adverse reactions.

The role of pre-donation blood pressure (BP) as independent contributor to post-donation vasovagal reactions (VVRs) is still debated. Differences between a liberal (i.e., inclusion of hypotensive donors) and a restrictive policy (i.e., not accepting hypotensive donors) should be investigated. This study aims to investigate the consequences of a liberal policy in development of VVRs after whole-blood donations. We compared the incidence of VVRs between 2015 (restrictive policy) and 2016 (liberal policy) and the associated risk factors. We evaluated respectively 22789 vs. 21676 blood donations obtained from 18001 blood donors (12501 donated in both years). Comparing the results we obtained between 2015 and 2016, donations showed an overlap of the cohorts. Two hundred fifteen VVRs (incidence rate 0·48%) were observed, 104 (0·46%) of which in 2015, and 111 (0·51%) in 2016. A preliminary univariate analysis showed that donors with systolic BP <110mmHg had a two-fold risk of VVRs compared to normotensive donors (VVR/donation rate of 0·99% vs. 0·46%; P=0·001). The subsequent multivariable logistic regression model showed that VVRs were highly associated with weight, site of collection, age and number of donations, excluding a role for systolic and diastolic BP. A liberal pre-donation BP policy seems to be safe for blood donors. Our analysis confirms that older donors with higher body-weight who already had donated blood are unlikely to experience VVRs.

Negative experiences and pre-donation blood pressure: the role of attitude and anxiety.

Negative experiences (NEs) have been shown to result in an increased stress response, as indicated by blood pressure, at the subsequent donation. This response might be influenced by how the donor rates the donation in terms of importance and pleasantness [affective attitude (AA)/cognitive attitude (CA)] or by anxiety about donating blood. We investigated the effect of AA/CA/anxiety on the impact of NEs on pre-donation blood pressure (pd-BP) in the subsequent donation. pd-BP at visit 3 was compared between donors with and without a history of NEs during or after their first two visits (visit 1: medical check, visit 2: first donation). The effect of AA/CA/anxiety (measured 1 month prior to visit 1 on a 7-point scale) on visit 3 pd-BP was explored using linear regression and interaction analyses. Analyses were stratified for gender, age and pd-BP at visit 1, which were taken into account as confounders. In 1106 first-time blood donors (70% female), 632 donors (57% of total) indicated an NE at their first donation. Mean scores for AA/CA/anxiety were 5·2/6·5/2·2 (men without NE), 4·8/6·3/3·0 (men with NE), 5·2/6·6/2·6 (women without NE) and 4·8/6·6/3·2 (women with NE). No significant associations were found for NE and pd-BP at visit 3 after adjusting for confounding. Of 48 interaction effects, four were significant, but effects were small and inconsistent. In donors who had had negative experiences during their first donation, anxiety and attitude to donation did not influence their pre-donation blood pressure at their subsequent visit.

Impact of Elevated Hemoglobin and Serum Protein on Vasovagal Reaction from Blood Donation.

We conducted a cross-sectional study to elucidate factors contributing to vasovagal reaction (VVR), the most frequent side effect following whole blood and apheresis donations. Complications recorded at the collection sites after voluntary donations by the Japanese Red Cross Tokyo Blood Center (JRC), in the 2006 and 2007 fiscal years, were analyzed by both univariate analysis and the multivariate conditional logistic regression model. Of 1,119,716 blood donations over the full two years, complications were recorded for 13,320 donations (1.18%), among which 67% were VVR. There were 4,303 VVR cases which had sufficient information and could be used for this study. For each VVR case, two sex- and age-matched controls (n = 8,606) were randomly selected from the donors without complications. Age, sex, body mass index (BMI), predonation blood pressure, pulse and blood test results, including total protein, albumin, and hemoglobin, were compared between the VVR group and the control group. In univariate analysis, the VVR group was significantly younger, with a lower BMI, higher blood pressure and higher blood protein and hemoglobin levels than the control group (p<0.001). Furthermore, blood protein and hemoglobin levels showed dose-dependent relationships with VVR incidences by the Cochran-Armitage trend test (p<0.01). For both sexes, after adjusting for confounders with the multivariate conditional logistic regression model, the higher than median groups for total protein (male: OR 1.97; 95%CI 1.76,-2.21; female: OR 2.29; 95%CI 2.05–2.56), albumin (male: 1.75; 1.55–1.96; female: 1.76; 1.57–1.97) and hemoglobin (male: 1.98; 1.76–2.22; female: 1.62; 1.45–1.81) had statistically significant higher risk of VVR compared to the lower than median groups. These elevated serum protein and hemoglobin levels might offer new indicators to help understand VVR occurrence.

Negative experiences and predonation blood pressure at the subsequent donation in blood donors.

Negative donation experiences, like being deferred or experiencing an adverse reaction, might upset blood donors, resulting in anticipatory stress responses such as elevated blood pressure at the subsequent visit. We therefore explored associations between blood donors' negative donation experiences and their blood pressure at the subsequent visit. Blood pressure of donors with no history of negative experiences in three consecutive donations was compared to the blood pressure of donors with a negative experience during the second of the three donations. Blood pressure (systolic and diastolic) measured prior to the third donation was compared between the two groups, using linear regression analyses. Two types of negative experiences (adverse reactions and deferral) were analysed, stratifying for donation type and sex, and adjusting for age and predonation blood pressure at baseline. In total, 248118 (50% female) donors were included in the analyses. Eleven per cent (26380 donors, 61% female) had experienced a negative experience. Fainting and dizziness were associated with significant (P<0·05) increases in systolic blood pressure: in men, 3·0mmHg (fainting) and 2·0mmHg (dizziness); in women, 2·0mmHg (fainting) and 1·4mmHg (dizziness). Deferral was associated with significant (P<0·05) increases in both systolic (men: 0·7mmHg, women: 0·3mmHg) and diastolic (men: 0·2mmHg, women: 0·3mmHg) blood pressure. Whole blood donations with negative experiences were associated with a statistically significant higher predonation blood pressure at the subsequent visit. This indicates that negative experiences might cause an anticipatory stress reaction in a subsequent donation.

O6-5.3 Vasovagal reaction from blood donation and biomarkers in Japanese

IntroductionThe Japanese Red Cross Tokyo Blood Center collects approximately 600 000 blood donations every year. Since we experienced a fatal injury case related to vasovagal reaction (VVR) syncope in 2005,...

Frequency of Adverse Events during Blood and Apheresis Donations: A Single-Center Study

Background: Blood and apheresis donations are widely considered safe, with a low incidence of adverse reactions and injuries. However, data reported in the medical literature on the prevalence of adverse events in donors and studies on the predictive risk factors for donor reactions are limited and contradictory. Material and Methods: From January 1998 to June 2001, we recorded at our transfusion center all adverse events occurring during 116,952 consecutive blood and apheresis donations (homologous and autologous whole blood donation, plasmapheresis and plateletpheresis). Results: 1,960 adverse events were reported (1.7% of all donations). With a frequency of 1.2%, vasovagal reactions, mostly of mild intensity, were the most commonly observed adverse event. The frequency of vasovagal reactions was significantly lower in autologous blood and apheresis donations than in homologous blood donations. Hematoma at the venipuncture site was the second most frequent adverse effect with a rate of 0.4%. A mild to moderate citraterelated toxicity was observed in 0.3% of apheresis donations. With an overall rate of 0.02%, severe adverse reactions (vasovagal, citrate-related and cardiopulmonary events) were very rare. No life-threatening adverse effect was reported, and no severe adverse event required hospitalization. Finally, we found that those donors who experienced adverse reactions were primarily first-time donors, were younger, and had a lower weight and predonation blood pressure than donors without reactions. Conclusions: Blood and apheresis donations are safe procedures with a low incidence of adverse reactions. Young age, first-time donation status, low weight and predonation blood pressure are predictive factors of donor reactions.

A case-controlled multicenter study of vasovagal reactions in blood donors: influence of sex, age, donation status, weight, blood pressure, and pulse.

Vasovagal reactions occur in a small, but significant number of blood donors. These reactions may decrease return donation and disrupt blood collection activities. The purpose of this study was to define the contributory role of sex, age, weight, blood pressure, and pulse in vasovagal reactions with syncope in blood donors. A retrospective case-control study involved 1890 blood donors with syncope from three large United States blood centers during 1994 and 1995. Case controls and random population controls were used in a logistic regression analysis to determine the significance of individual variables to syncopal reactions. Female donors, young donors, first-time donors, low-weight donors, and donors with low predonation blood pressure had higher absolute donation reaction rates than other donors. When each variable was adjusted for other variables by regression analysis, age, weight, and donation status (first-time or repeat donor) were significant (p<0.0001), and sex, predonation blood pressure, and predonation pulse were not. The most important variables, in descending order, were age, weight, and donation status (first-time or repeat donor). Donation-related vasovagal syncopal reactions are a multifactorial process determined largely by age, weight, and first-time donor status.