Uncontrolled hypertension is associated with increased risk of graft failure in kidney transplant recipients: a nationwide population-based study

Area of Science:

• Nephrology
• Transplantation Medicine
• Cardiovascular Research

Background:

• Hypertension is a common complication following kidney transplantation.
• Immunologic and non-immunologic factors contribute to post-transplant hypertension.
• The association between strict hypertension definitions and graft failure risk remains unclear.

Purpose of the Study:

• To investigate the relationship between hypertension, defined by strict blood pressure thresholds, and graft failure risk in kidney transplant recipients.
• To analyze the impact of different blood pressure categories on graft failure.
• To evaluate the association of elevated blood pressure and pulse pressure with graft failure.

Main Methods:

• A nationwide cohort study using Korean National Health Insurance Service data.
• Included 14,249 kidney transplant recipients from 2002 to 2016.
• Patients were classified into five blood pressure groups based on 2021 KDIGO guidelines, including normal, elevated, incident hypertension, and controlled/uncontrolled hypertension.

Main Results:

• Graft failure occurred in 13.6% of participants over a 6-year follow-up.
• Hypertension (≥130/80 mmHg) was associated with a 1.70-fold increased risk of graft failure.
• Uncontrolled hypertension showed the highest risk (AHR, 2.13), with a linear relationship observed between blood pressure levels and graft failure risk.

Conclusions:

• Strict hypertension definition (≥130/80 mmHg) per 2021 KDIGO guidelines is linked to increased graft failure risk in kidney transplant recipients.
• Elevated systolic and diastolic blood pressure, as well as pulse pressure, are associated with higher graft failure risk.
• Effective blood pressure management is crucial for improving graft survival in kidney transplant patients.