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Published on: July 15, 2015
Living donor kidney donation: another form of white coat effect
Stephanie S DeLoach1, Kevin E C Meyers, Raymond R Townsend
1Departments of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
Insights
Ambulatory blood pressure monitoring (ABPM) is superior for assessing blood pressure in living kidney donors. Clinic blood pressure readings may be elevated due to the white coat effect, masking true donor health.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Transplantation
Background:
- Living donor nephrectomy may lead to long-term blood pressure increases.
- Optimal blood pressure assessment methods during donor evaluation are not well-established.
Purpose of the Study:
- To compare clinic blood pressure monitoring with ambulatory blood pressure monitoring (ABPM) and central aortic pressures in living kidney donors.
- To identify the most accurate method for blood pressure assessment before and after kidney donation.
Main Methods:
- Living kidney donors underwent casual clinic and ABPM, plus central aortic pressure measurements.
- These assessments were performed at baseline and 6 months post-nephrectomy.
Main Results:
- Clinic systolic blood pressure (SBP) and central aortic systolic pressure significantly declined post-donation.
- Ambulatory blood pressure monitoring (ABPM) revealed no significant change in average blood pressure.
- Central arterial pressures and Augmentation Index remained unchanged at 6 months.
Conclusions:
- A significant white coat effect on clinic SBP was observed in living kidney donors.
- This effect diminished 6 months after nephrectomy.
- ABPM is recommended for more accurate blood pressure assessment in living kidney donor evaluations.
Background/Aims:
Living donor nephrectomy can be associated with increases in blood pressure several years following the procedure, but the best method to assess blood pressure during the living donor evaluation process is unclear.
Methods:
Living kidney donors underwent casual clinic and ambulatory blood pressure monitoring (ABPM) and measurement of central aortic pressures at baseline and 6 months following donor nephrectomy.
Results:
There was a significant decline in clinic systolic blood pressure (SBP; p = 0.001) and central aortic systolic pressure (p = 0.011) during the study period. However, average ABPM was unchanged and other measures of central arterial pressures and Augmentation Index were unchanged at 6 months compared to baseline.
Conclusions:
The remarkable differences between clinic SBP and ambulatory SBP prior to donation, and the disappearance of these differences 6 months later, suggest a substantial white coat effect on SBP associated with living kidney donor evaluation. Also, ABPM represents a better way to assess blood pressure prior to kidney donation.
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