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Possible causes and consequences of hypertension in stable renal transplant patients
1Department of Medicine, University of Minnesota College of Medicine, Hennepin County Medical Center, Minneapolis 55415.
Insights
Hypertension is common in renal transplant recipients, affecting over half at one year. Key risk factors include body weight and allograft function, impacting long-term outcomes.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Previous studies on hypertension in renal transplant patients yielded conflicting findings.
- Chronic hypertension is a significant concern in kidney transplant recipients.
Purpose of the Study:
- To determine the incidence and clinical predictors of chronic hypertension in stable renal transplant patients.
- To identify factors associated with hypertension and its consequences post-transplantation.
Main Methods:
- A multivariate approach was used to analyze data from 201 stable renal transplant patients.
- Discriminant analysis identified key variables associated with hypertension at one year and long-term follow-up.
Main Results:
- Hypertension was observed in 52.7% at one year and 46.3% at long-term follow-up (5.0 years).
- Associated factors included body weight, native kidneys, and allograft function; initially also age, sex, pretransplant hypertensive nephrosclerosis, and diabetes.
- Hypertensive patients showed greater renal function decline, higher serum lipids, and increased mortality or return to dialysis.
Conclusions:
- Body weight, native kidneys, and allograft function are crucial factors in renal transplant-associated hypertension.
- Hypertension significantly impacts renal function, lipid profiles, and patient survival after transplantation.
Abstract:
Previous epidemiologic studies of hypertension in renal transplant patients have produced contradictory results. Therefore, the incidence and clinical setting of chronic hypertension were examined in 201 stable renal transplant patients using a multivariate approach. Hypertension was present in 52.7% of patients at one year, and in 46.3% at the time of last follow-up, 5.0 +/- 1.9 years (mean +/- SD) after transplantation. Among possible causative factors, discriminant analysis demonstrated that body weight, the presence of native kidneys, and variables linked to allograft function were most closely associated with hypertension at both one year and last follow-up. One year after transplantation, age, sex, pretransplant hypertensive nephrosclerosis, and diabetes were also independently associated with hypertension. However, renal function declined to a greater degree in hypertensive patients, and only body weight, the presence of native kidneys, and variables linked to allograft function were associated with hypertension at last follow-up. Results also demonstrated that hypertension was associated with elevated serum lipid levels and an increased likelihood of dying or returning to dialysis. Thus, these results suggested several important risk factors for hypertension and its consequences in renal transplant patients.