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Hypertension after kidney transplantation
Bertram L Kasiske1, Shakeel Anjum, Rajiv Shah
1Department of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA. kasis001@umn.edu
Summary
High blood pressure (BP) after kidney transplants is common and poorly controlled, independently increasing risks for graft failure and death. Improved BP management strategies are crucial for better patient outcomes.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Limited research exists on blood pressure's (BP) impact post-kidney transplant, separate from acute rejection and graft function.
- Understanding hypertension's role is vital for improving long-term kidney transplant outcomes.
Purpose of the Study:
- To investigate the prevalence, treatment, control, and clinical factors associated with hypertension in kidney transplant recipients.
- To determine the independent association between BP and patient/graft survival after kidney transplantation.
Main Methods:
- Retrospective cohort study of 1,666 kidney transplant recipients.
- Multivariate analyses with time-dependent covariates were employed.
- Evaluated hypertension prevalence, treatment, control, and clinical correlates.
Main Results:
- Hypertension was prevalent with suboptimal control; only 55.5% achieved BP < 140 mm Hg at 1 year.
- Independent predictors of higher BP included male sex, age, diabetes, obesity, and delayed graft function.
- Each 10 mm Hg increase in systolic BP independently raised the relative risk of graft failure (1.12), death-censored graft failure (1.17), and mortality (1.18).
Conclusions:
- Elevated BP is an independent risk factor for graft failure and mortality in kidney transplant recipients, despite its link to graft function.
- Current strategies for BP control post-transplantation are insufficient.
- Enhanced BP management protocols are necessary to improve survival and graft longevity.