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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Arterial stiffness and blood pressure increase in pediatric kidney transplant recipients
Rizky Indrameikha Sugianto1, Karen Ostendorf1, Elena Bauer1
1Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Insights
Increased blood pressure (BP) significantly elevates arterial stiffness (measured by pulse wave velocity, PWV) in children post-kidney transplant. Managing BP is crucial for improving cardiovascular health in these patients.
Area of Science:
- Cardiovascular Medicine
- Pediatric Nephrology
- Transplantation Science
Background:
- Pulse wave velocity (PWV) quantifies arterial stiffness, a key indicator of cardiovascular risk.
- Kidney transplantation in children can impact cardiovascular health, necessitating investigation into factors like blood pressure (BP) and arterial stiffness.
Purpose of the Study:
- To determine the contribution of blood pressure (BP) changes to arterial stiffness in pediatric kidney transplant recipients.
- To identify factors influencing BP in children following kidney transplantation.
Main Methods:
- Utilized linear mixed modeling to analyze PWV z-score (PWVz) in relation to systolic (SBP) and diastolic BP (DBP) changes in 70 children post-transplant.
- Assessed BP, immunosuppression (cyclosporin A, everolimus), and creatinine in an extended dataset of 35 participants over a median of 74 months.
Main Results:
- PWVz increased by 0.11/year. Greater increases in SBP and DBP were significantly associated with higher PWVz.
- Female sex and lower estimated glomerular filtration rate (eGFR) correlated with increased PWVz.
- Higher DBP was linked to elevated cyclosporin A and everolimus trough levels.
Conclusions:
- Elevated BP is a significant contributor to increased arterial stiffness in pediatric kidney transplant patients.
- BP management is a critical modifiable factor for improving cardiovascular outcomes post-transplantation.
- Immunosuppressants like cyclosporin A and everolimus may influence BP levels.
Background:
Pulse wave velocity (PWV) is a measure of arterial stiffness. We investigated PWV and blood pressure (BP) to determine to what extent BP changes contribute to arterial stiffness, and secondly, to identify influencing factors on BP in children after kidney transplantation.
Methods:
Seventy children ≥ 2.5 years post-transplantation with at least two PWV measurements were included. Changes of systolic (Δ SBP) and diastolic BP (Δ DBP) were classified into "stable/decreasing," "1-10 mmHg increase," and " > 10 mmHg increase." Linear mixed modeling for PWV z-score (PWVz) adjusted either for Δ SBP or Δ DBP was performed. An extended dataset with monthly entries of BP, immunosuppression, and creatinine was obtained in 35 participants over a median of 74 months to perform linear mixed modeling for SBP and DBP.
Results:
PWVz increased with a rate of 0.11/year (95% CI 0.054 to 0.16). Compared to participants with stable BP, those with 1-10-mmHg SBP and DBP increase showed a higher PWVz of 0.59 (95% CI 0.046 to 1.13) and 0.86 (95% CI 0.43 to 1.30), respectively. A > 10-mmHg BP increase was associated with an even higher PWVz (SBP β = 0.78, 95% CI 0.22 to 1.34; DBP β = 1.37, 95% CI 0.80 to 1.94). Female sex and participants with lower eGFR showed higher PWVz. In the extended analysis, DBP was positively associated with cyclosporin A and everolimus trough levels.
Conclusions:
A higher increase of PWV is seen in patients with greater BP increase, with higher cyclosporin A and everolimus trough levels associated with higher BP. This emphasizes the role of BP as a modifiable risk factor for the improvement of cardiovascular outcome after transplantation. A higher resolution version of the Graphical abstract is available as Supplementary information.
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