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Association of pre‐transplant blood pressure with post‐transplant outcomes
Author(s) -
Molnar Miklos Z.,
Foster Clarence E.,
Sim John J.,
Remport Adam,
Krishnan Mahesh,
Kovesdy Csaba P.,
KalantarZadeh Kamyar
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12292
Subject(s) - dialysis , medicine , blood pressure , diastole , hazard ratio , transplantation , cardiology , kidney transplantation , hemodialysis , cohort , confidence interval
Background Previous studies have indicated U ‐shaped associations between blood pressure ( BP ) and mortality in dialysis patients. We hypothesized that a similar association exists between pre‐transplant BP and post‐transplant outcomes in dialysis patients who undergo successful kidney transplantation. Methods Data from the S cientific R egistry of T ransplant R ecipients were linked to the five‐yr cohort of a large dialysis organization in the U nited S tates. We identified all dialysis patients who received a kidney transplant during this period. Unadjusted and multivariate adjusted predictors of transplant outcomes were examined. Results A total of 13 881 patients included in our study were 47 ± 14 yr old and included 42% women. There was no association between pre‐transplant systolic BP and post‐transplant mortality, although a decreased risk trend was observed in those with low post‐dialysis systolic BP . Compared to patients with pre‐dialysis diastolic BP 70 to <80 mmHg, patients with pre‐dialysis diastolic BP <50 mmHg experienced lower risk of post‐transplant death (hazard ratios [ HR ]: 0.74, 95% CI : 0.55–0.99). However, compared to patients with post‐dialysis diastolic BP 70 to <80 mmHg, patients with post‐dialysis diastolic BP ≥100 mmHg experienced higher risk of death ( HR : 3.50, 95% CI : 1.57–7.84). In addition, very low (<50 mmHg for diastolic BP and <110 mmHg for systolic BP ) pre‐transplant BP was associated with lower risk of graft loss. Conclusions Low post‐dialysis systolic BP and low pre‐dialysis diastolic BP are associated with lower post‐transplant risk of death, whereas very high post‐dialysis diastolic BP is associated with higher mortality in kidney transplant recipients. BP variations in dialysis patients prior to kidney transplantation may have a bearing on post‐transplant outcome, which warrants additional studies.