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Yilmaz R, Yildirim T, Abudalal A, Erdem Y. Impact of the kidney transplantation on renalase and blood pressure levels in renal transplant donors and recipients. Nefrologia 2022; 42:171-176. [PMID: 36153913 DOI: 10.1016/j.nefroe.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/28/2021] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Prevalence of hypertension increases as glomerular filtration rate (GFR) declines. Renalase metabolizes catecholamines and have an important role in blood pressure (BP) regulation. The purpose of the study was to evaluate the effect of kidney transplantation on renalase levels and BP in kidney donors and recipients. MATERIALS AND METHODS Twenty kidney transplant recipients and their donors were included in the study. Serum renalase levels and ambulatory BP values were measured in both donors and recipients before and after transplantation. Factor associated with change in renalase and BP levels were also evaluated. RESULTS In donors; mean GFR and hemoglobin levels decreased while night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels and serum renalase levels increased simultaneously after nephrectomy. Day-time SBP and DBP levels did not changed and the night/day ratio of mean arterial pressure (MAP) increased significantly. In recipients, mean GFR increased, while mean serum renalase levels, creatinine and BP levels decreased after transplantation. Correlation analysis revealed that changes in MAP correlated with alteration in serum renalase levels and GFR. CONCLUSIONS After transplantation, serum renalase levels increased in donors and decreased in recipients. The renalase levels are associated with change in MAP and circadian rhythm of BP in donors and recipients.
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Affiliation(s)
- Rahmi Yilmaz
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey.
| | - Tolga Yildirim
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
| | - Ayman Abudalal
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
| | - Yunus Erdem
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
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Yilmaz R, Yildirim T, Abudalal A, Erdem Y. Impact of the kidney transplantation on renalase and blood pressure levels in renal transplant donors and recipients. Nefrologia 2021; 42:S0211-6995(21)00111-9. [PMID: 34281748 DOI: 10.1016/j.nefro.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Prevalence of hypertension increases as glomerular filtration rate (GFR) declines. Renalase metabolizes catecholamines and have an important role in blood pressure (BP) regulation. The purpose of the study was to evaluate the effect of kidney transplantation on renalase levels and BP in kidney donors and recipients. MATERIALS AND METHODS Twenty kidney transplant recipients and their donors were included in the study. Serum renalase levels and ambulatory BP values were measured in both donors and recipients before and after transplantation. Factor associated with change in renalase and BP levels were also evaluated. RESULTS In donors; mean GFR and hemoglobin levels decreased while night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels and serum renalase levels increased simultaneously after nephrectomy. Day-time SBP and DBP levels did not changed and the night/day ratio of mean arterial pressure (MAP) increased significantly. In recipients, mean GFR increased, while mean serum renalase levels, creatinine and BP levels decreased after transplantation. Correlation analysis revealed that changes in MAP correlated with alteration in serum renalase levels and GFR. CONCLUSIONS After transplantation, serum renalase levels increased in donors and decreased in recipients. The renalase levels are associated with change in MAP and circadian rhythm of BP in donors and recipients.
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Affiliation(s)
- Rahmi Yilmaz
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey.
| | - Tolga Yildirim
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
| | - Ayman Abudalal
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
| | - Yunus Erdem
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
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Jeong JH, Fonkoue IT, Quyyumi AA, DaCosta D, Park J. Nocturnal blood pressure is associated with sympathetic nerve activity in patients with chronic kidney disease. Physiol Rep 2020; 8:e14602. [PMID: 33112490 PMCID: PMC7592496 DOI: 10.14814/phy2.14602] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/04/2023] Open
Abstract
Elevated nocturnal blood pressure (BP) and nocturnal non-dipping are frequently observed in patients with chronic kidney disease (CKD) and are stronger predictors of cardiovascular complications and CKD progression than standard office BP. The sympathetic nervous system (SNS) is thought to modulate diurnal hemodynamic changes and the vascular endothelium plays a fundamental role in BP regulation. We hypothesized that SNS overactivity and endothelial dysfunction in CKD are linked to elevated nocturnal BP and non-dipping. In 32 CKD patients with hypertension (56 ± 7 years), office BP, 24-hr ambulatory BP, muscle sympathetic nerve activity (MSNA) and endothelial function via flow-mediated dilation (FMD) were measured. Participants were subsequently divided into dippers (nighttime average BP > 10% lower than the daytime average BP, n = 8) and non-dippers (n = 24). Non-dippers had higher nighttime BP (p < .05), but not office and daytime BP, compared to dippers. MSNA burst incidence (81 ± 13 versus 67 ± 13 bursts/100 HR, p = .019) was higher and brachial artery FMD (1.7 ± 1.5 versus 4.7 ± 1.9%, p < .001) was lower in non-dippers compared to dippers. MSNA and FMD each predicted nighttime systolic (β = 0.48,-0.46, p = .02, 0.07, respectively) and diastolic BP (β = 0.38,-0.47, p = .04, 0.03, respectively) in multivariate-adjusted analyses. Our novel findings demonstrate that unfavorable nocturnal BP profiles are associated with elevated SNS activity and endothelial dysfunction in CKD. Specifically, CKD patients with higher nighttime BP and the non-dipping pattern have higher MSNA and lower FMD. These support our hypothesis that SNS overactivation and endothelial dysfunction are linked to the dysregulation of nighttime BP as well as the magnitude of BP lowering at nighttime in CKD.
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Affiliation(s)
- Jin H. Jeong
- Division of Renal MedicineDepartment of MedicineEmory University School of MedicineAtlantaGAUSA
- Department of Veterans Affairs Health Care SystemResearch Service LineDecaturGAUSA
| | - Ida T. Fonkoue
- Division of Renal MedicineDepartment of MedicineEmory University School of MedicineAtlantaGAUSA
- Department of Veterans Affairs Health Care SystemResearch Service LineDecaturGAUSA
| | - Arshed A. Quyyumi
- Division of CardiologyDepartment of MedicineEmory University School of medicineAtlantaGAUSA
| | - Dana DaCosta
- Division of Renal MedicineDepartment of MedicineEmory University School of MedicineAtlantaGAUSA
- Department of Veterans Affairs Health Care SystemResearch Service LineDecaturGAUSA
| | - Jeanie Park
- Division of Renal MedicineDepartment of MedicineEmory University School of MedicineAtlantaGAUSA
- Department of Veterans Affairs Health Care SystemResearch Service LineDecaturGAUSA
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Kendirlinan Demirkol O, Oruc M, Ikitimur B, Ozcan S, Gulcicek S, Soylu H, Trabulus S, Altiparmak MR, Seyahi N. Ambulatory Blood Pressure Monitoring and Echocardiographic Findings in Renal Transplant Recipients. J Clin Hypertens (Greenwich) 2016; 18:766-71. [PMID: 26689296 PMCID: PMC8032182 DOI: 10.1111/jch.12755] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/22/2015] [Accepted: 10/25/2015] [Indexed: 12/15/2022]
Abstract
Hypertension is common in renal transplant recipients (RTRs). Ambulatory blood pressure (BP) monitoring (ABPM) is important in diagnosing hypertension and diurnal BP variation. The authors set out to compare office BP and ABPM measurements to determine diurnal pattern and to evaluate echocardiographic findings in RTRs. ABPM and office BP measurements were compared in 87 RTRs. Echocardiographic evaluation was performed for each patient. The correlations between office and 24-hour ABPM were 0.275 for mean systolic BP (P=.011) and 0.260 for mean diastolic BP (P=.017). Only 36.8% had concordant hypertension between office BP and ABPM, with a masked hypertension rate of 16.1% and white-coat effect rate of 24.1%. Circadian BP patterns showed a higher proportion of nondippers (67.8%). Left ventricular mass index was increased in 21.8% of all recipients. There was a significant but weak correlation between office BP and ABPM.
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Affiliation(s)
| | - Meric Oruc
- Division of NephrologyDepartment of Internal MedicineCerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
| | - Baris Ikitimur
- Department of CardiologyCerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
| | - Sevgi Ozcan
- Department of CardiologyCerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
| | - Sibel Gulcicek
- Division of NephrologyDepartment of Internal MedicineCerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
| | - Hikmet Soylu
- Department of Internal MedicineCerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
| | - Sinan Trabulus
- Division of NephrologyDepartment of Internal MedicineCerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
| | - Mehmet Riza Altiparmak
- Division of NephrologyDepartment of Internal MedicineCerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
| | - Nurhan Seyahi
- Division of NephrologyDepartment of Internal MedicineCerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
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Agarwal R, Satyan S, Alborzi P, Light RP, Tegegne GG, Mazengia HS, Yigazu PM. Home blood pressure measurements for managing hypertension in hemodialysis patients. Am J Nephrol 2009; 30:126-34. [PMID: 19246891 DOI: 10.1159/000206698] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/25/2009] [Indexed: 01/05/2023]
Abstract
Home blood pressure (BP) monitoring serves as a practical method to detect changes in BP instead of ambulatory BP monitoring in hemodialysis patients. To evaluate the relationship of reduction in home BP compared to interdialytic ambulatory BP measurements we analyzed the data from the dry-weight reduction in hypertensive hemodialysis patients (DRIP) trial in which 100 patients had their dry weight probed based on clinical sign and symptoms and 50 patients served as controls. We measured home BP 3 times a day for 1 week using a validated oscillometric monitor on 3 occasions at 4-week intervals after randomization. Changes from baseline in home, predialysis BP and postdialysis BP were compared to interdialytic 44-hour ambulatory BP. Home and ambulatory BP monitoring was available in 141 of 150 (94%) patients. Predialysis systolic BP was not as sensitive as ambulatory BP in detecting change in BP with dry-weight reduction. Whereas postdialysis BP was capable of detecting an improvement in systolic BP in response to probing dry weight, by itself it does not provide evidence that change in postdialysis BP persists over the interdialytic period. Home BP reliably detected changes in ambulatory BP, albeit with less sensitivity at 4 weeks. However, at 4 and at 8 weeks, changes in home systolic BP were most strongly related to changes in interdialytic ambulatory systolic BP compared to predialysis and postdialysis BP. The reproducibility of BP measurements followed the order home > ambulatory >> predialysis > postdialysis. These data provide support for the use of home BP monitoring for the management of hypertension in hemodialysis patients.
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Affiliation(s)
- Rajiv Agarwal
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Ind., USA.
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Kanbay M, Turgut F, Uyar ME, Akcay A, Covic A. Causes and mechanisms of nondipping hypertension. Clin Exp Hypertens 2009; 30:585-97. [PMID: 18855262 DOI: 10.1080/10641960802251974] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Growing evidence indicates that nondippers have worsened cardiovascular outcomes than dippers. Ambulatory blood pressure monitoring with a lack of nocturnal BP fall (nondipping) have also been shown to be more closely associated with target organ damage and worsened cardiovascular outcome than in patients with essential hypertension with dipping pattern. The underlying pathogenetic mechanisms potentially linking nondipping with cardiovascular disease are not fully understood. There are multiple possible underlying pathophysiologic mechanisms in the impaired BP decline during the night. Extrinsic and intrinsic factors including abnormal neurohormonal regulation, lack of physical activity, nutritional factors such as increased dietary sodium intake, and smoking of tobacco have been implicated for blunted circadian rhythm of BP. Certain diseases such as diabetes and chronic renal diseases also affect the circadian BP rhythm. Currently, the clinical importance of nondipping is known well; however, the relationship between certain disease states and nondipping has not been fully explained yet. This paper will attempt to address to clarify the underlying basis for nondipping and the specific associations with various disease states.
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Affiliation(s)
- Mehmet Kanbay
- Department of Internal Medicine, Section of Nephrology, Fatih University School of Medicine, Ankara, Turkey.
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Rohrscheib MR, Myers OB, Servilla KS, Adams CD, Miskulin D, Bedrick EJ, Hunt WC, Lindsey DE, Gabaldon D, Zager PG. Age-related blood pressure patterns and blood pressure variability among hemodialysis patients. Clin J Am Soc Nephrol 2008; 3:1407-14. [PMID: 18701616 DOI: 10.2215/cjn.00110108] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite the high prevalence of cardiovascular disease among hemodialysis patients, the relationship between age and blood pressure (BP) is not well understood. It was postulated that the relationship of BP to age differs among hemodialysis patients versus the general population and that there is significant variability in dialysis unit BP measurements. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS To explore this hypothesis, the patterns of systolic, diastolic, mean arterial, and pulse pressures in the general population using data from National Health and Nutrition Examination Survey participants (n = 9242) were compared with those in a cohort of hemodialysis patients (n = 9849). RESULTS In contrast to the increase in systolic BP with age in the general population, systolic BP was elevated in young hemodialysis patients and declined slightly among the elderly. The inverted "U"-shape relationship between age and diastolic BP in the general population was absent in hemodialysis patients. Diastolic BP was elevated among hemodialysis patients <50 yr of age and declined with advancing age. Mean arterial and pulse pressures were elevated among young hemodialysis patients and exhibited less age dependency than in the general population. Variability in BP within patients was similar to that between patients. CONCLUSIONS The relationship of BP to age differed from that in the general population. The variability in dialysis unit BP measurements may limit their use in managing hypertension and predicting outcomes. Nevertheless, dialysis unit BP measurements are necessary to minimize acute complications during the dialysis procedure.
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Affiliation(s)
- Mark R Rohrscheib
- Department of Internal Medicine, Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, USA
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Agarwal R, Andersen MJ. Blood pressure recordings within and outside the clinic and cardiovascular events in chronic kidney disease. Am J Nephrol 2006; 26:503-10. [PMID: 17124383 DOI: 10.1159/000097366] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Accepted: 10/19/2006] [Indexed: 01/13/2023]
Abstract
BACKGROUND Blood pressure (BP) measured outside the clinic correlates better with cardiovascular outcomes in patients with essential hypertension. To assess the role of out-of-clinic BP recordings in predicting cardiovascular events in patients with chronic kidney disease (CKD), a prospective cohort study was conducted in 217 veterans with CKD. METHODS BP was measured outside the clinic at home and by 24-hour ambulatory recordings, and in the clinic by 'routine' and standardized methods. Patients were followed over a median of 3.4 years to assess the combined end-point of total mortality, myocardial infarction or stroke. RESULTS Average (+/-SD) home BP was 147.0 +/- 21.4/78.3 +/- 11.6 mm Hg, 24-hour ambulatory BP 133.5 +/- 16.6/73.1 +/- 11.1 mm Hg and in-clinic BPs were 155.2 +/- 25.6/84.7 +/- 14.2 mm Hg by the standardized method, and 144.5 +/- 24.2/75.4 +/- 14.7 mm Hg by the 'routine' method. A 1 SD increase in systolic BP increased the hazard ratio (HR) of the composite end-point by 1.16 (95% CI 0.89-1.50) for routine BP, 1.57 (95% CI 1.19-2.09) for standardized BP, 1.66 (95% CI 1.27-2.17) for home BP, and 1.42 (95% CI 1.10-1.84) for 24-hour ambulatory BP recording. The HR of the composite end-point was only significant for hypertension defined by 24-hour ambulatory BP monitoring (HR 2.22 (95% CI 1.23-4.01)). Adjusted for the propensity scores, BP measured by the ambulatory technique was not an independent predictor of cardiovascular events. Non-dipping was associated with increased cardiovascular risk, but not when adjusted for other risk factors. CONCLUSION Risk factors that differentiate hypertension or non-dipping appear to confer a cardiovascular risk in CKD.
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Affiliation(s)
- Rajiv Agarwal
- Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN 46202, USA.
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Campese VM, Mitra N, Sandee D. Hypertension in renal parenchymal disease: why is it so resistant to treatment? Kidney Int 2006; 69:967-73. [PMID: 16528245 DOI: 10.1038/sj.ki.5000177] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The association between hypertension and chronic renal disease is well known. The pathogenesis of hypertension in patients with chronic kidney disease (CKD) is complex and multifactorial, which may explain why it is resistant to treatment. The traditional paradigm is that hypertension in CKD is due either to an excess of intravascular volume (volume dependent) or to excessive activation of the renin-angiotensin system in relation to the state of sodium/volume balance (renin-dependent hypertension). This review focuses on the importance of less established mechanisms, such as increased activity of the sympathetic nervous system, increased endothelin production, decreased availability of endothelium-derived vasodilators and structural changes of the arteries, renal ischemia, and sleep apnea.
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Affiliation(s)
- V M Campese
- Department of Medicine, Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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Covic A, Gusbeth-Tatomir P, Mardare N, Buhaescu I, Goldsmith DJA. Dynamics of the circadian blood pressure profiles after renal transplantation. Transplantation 2006; 80:1168-73. [PMID: 16314781 DOI: 10.1097/01.tp.0000167003.97452.a8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abnormalities of diurnal blood pressure (BP) rhythm ("nondipping") are well-described in dialysis patients, and have prognostic importance. It is controversial whether successful renal transplantation (RTx) improves diurnal BP rhythm. To date, no study has attempted to define and model the evolution of diurnal BP rhythm profiles from dialysis to engraftment, focusing on the immediate (4-6 weeks) and medium-term (>1 year) postengraftment periods. METHODS To test if kidney transplantation normalizes the BP profile, ambulatory blood pressure monitoring (ABPM) was performed in 20 living related transplants (age, 30.3+/-5.1 years; 11 males, on dialysis for 25.6 months) 1 month preRTx and repeated 1 month and >1 year (ABPM3) after successful RTx. Dipping was defined as a sleep-to-awake ratio>0.92 (for systolic BP) and >0.90 (for diastolic BP). RESULTS PreRTx only 15% patients were dippers. At 1 month postRTx (creatinine clearance, 65.8 ml/min), all patients were complete nondippers. However, after >1 year postRTx (creatinine clearance, 70.4 ml/min), 40% were now dippers. Most importantly, overall, 30% of the patients improved significantly their circadian rhythm (35.3% of the initial preRTx nondippers). Despite successful renal transplantation, 55% patients maintained unchanged their nondipping profile throughout all three ABPM recordings. The only determinants of "long-term" postRTx circadian rhythm are the contemporary level of the renal function and the baseline, dialysis dipping profile: SBP3 sleep-to-awake ratio is related with serum creatinine3 (r=0.58, P=0.001), creatinine clearance (r=-0.41, P=0.036) and SBP1 sleep-to-awake ratio (r=0.48, P=0.034); similarly DBP3 sleep-to-awake ratio is related with serum creatinine3 (r=0.63, P=0.001), creatinine clearance (r=-0.471, P=0.036) and SBP1 sleep-to-awake ratio (r=0.53, P=0.016). In all, 57% of the variance in dipping status can be attributed and explained by the contribution of renal function and initial circadian variability. CONCLUSIONS Half of the nondipper dialysis patients maintain a permanently abnormal circadian rhythm, despite successful RTx. In the short term, RTx is associated with a highly abnormal diurnal profile, exclusively related to ciclosporin dose and levels. However, in the longer term, renal transplantation leads to a significant improvement of the circadian blood pressure profile, influenced by the renal function level and by the pretransplantation dipping profile.
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Affiliation(s)
- Adrian Covic
- Dialysis and Transplantation Center, C.I. Parhon University Hospital, Iasi, Romania. acovicxnet.ro
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Covic A, Haydar AA, Goldsmith DJA. Recent insights from studies using ambulatory blood pressure monitoring in patients with renal disease. Curr Opin Nephrol Hypertens 2005; 12:645-8. [PMID: 14564203 DOI: 10.1097/00041552-200311000-00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW To identify and evaluate recent (2000-2003) published studies employing ambulatory blood pressure monitoring in patients with chronic renal failure, on dialysis, and after renal transplantation. RECENT FINDINGS We discuss several studies that have employed ambulatory blood pressure monitoring to refine the analysis of the link between blood pressure levels, and diurnal alterations, and end-organ damage or patient survival. There is now some evidence that an abnormal diurnal blood pressure profile, although intrinsically not a very reproducible label, has predictive value for patient survival, and that the non-dipping phenomenon is linked to a high incidence of cardiovascular disease and autonomic dysfunction. SUMMARY Ambulatory blood pressure monitoring remains an important adjunct to the comprehensive cardiovascular evaluation of patients with chronic, end-stage renal failure or after renal transplantation.
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Affiliation(s)
- Adrian Covic
- Dialysis and Transplant Unit, Parhon Hospital, Iasi, Romania
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Abstract
PURPOSE OF REVIEW Hypertension is highly prevalent in dialysis patients and may be important to the high cardiovascular mortality of this population. This review shows the current direction in dialysis-associated hypertension management. RECENT FINDINGS Decreasing dialysate sodium concentration based on pre-hemodialysis plasma sodium concentration may have an additive effect in controlling hypertension. Sympathetic nervous system overactivity is an important feature of end-stage renal disease; a new amine oxidase, renalase, may be relevant to the pathogenesis of hypertension in this population. Similarly, drugs that block the sympathetic nervous system are uniformly protective in dialysis patients. Daily dialysis (short or long) results in better blood pressure control, and the mechanisms resulting in this effect are increasingly better understood. SUMMARY Long-term control of hypertension is necessary in dialysis patients. The better understanding of the dialysis-associated hypertension pathogenesis has impact on the dialysis prescription and antihypertensive drug choices.
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Affiliation(s)
- Sergio F F Santos
- Division of Nephrology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
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Mendes RB, Santos SFF, Dorigo D, Mansoor GA, Crowley ST, White WB, Peixoto AJ. The use of peridialysis blood pressure and intradialytic blood pressure changes in the prediction of interdialytic blood pressure in haemodialysis patients. Blood Press Monit 2004; 8:243-8. [PMID: 14688554 DOI: 10.1097/00126097-200312000-00004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE It is uncertain which blood pressure values (pre- or post-haemodialysis) best represent the average daily blood pressure in haemodialysis patients. The purpose of this study was to verify the power of peridialysis blood pressure to predict interdialytic blood pressure, and to ascertain the influence of blood pressure fluctuations during dialysis on this predictive ability. METHODS AND RESULTS We performed ambulatory blood pressure monitoring during the interdialytic period on 60 stable haemodialysis patients (mean age 53 +/- 16 years, 33 male) between two mid-week haemodialysis sessions. Pre- and post-haemodialysis blood pressures were 154/82 and 142/77 mmHg, respectively, and 44-h interdialytic blood pressure was 136/77 mmHg. Overall, post-haemodialysis blood pressure values correlated with interdialytic ambulatory blood pressure marginally better than did pre-haemodialysis values (r = 0.52 versus 0.61 for pre- and post-dialysis systolic pressure, respectively; r = 0.67 versus 0.72 for pre- and post-dialysis diastolic pressure, respectively). The average of the pre- and post-haemodialysis values showed a slightly better correlation with interdialytic blood pressure (r = 0.65 and 0.75 for systolic and diastolic pressure, respectively). When we stratified patients according to systolic blood pressure behaviour during dialysis, pre-dialysis blood pressure was the stronger predictor of interdialytic blood pressure in the quartile with greatest intradialytic blood pressure fall (r = 0.67 versus 0.44 for pre- and post-dialysis systolic blood pressure, respectively), whereas post-dialysis values were substantially better in the group with a rise in systolic pressure during dialysis (r = 0.26 versus 0.59 for pre- and post-dialysis systolic blood pressure, respectively). CONCLUSIONS These data demonstrate that peridialysis blood pressure values are of limited accuracy in predicting interdialytic blood pressure, post-dialysis values are minimally better predictors than pre-dialysis blood pressures, and the average of pre- and post-haemodialysis values is marginally better than both. In addition, blood pressure fluctuations during dialysis have a sizable impact on this predictive ability. Clinical decisions related to blood pressure management and research design in haemodialysis hypertension should take these factors into account.
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Affiliation(s)
- Roger B Mendes
- GAMEN - Grupo de Assistencia Medica e Nefrologica, Rio de Janeiro, Brazil
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Sankaranarayanan N, Santos SFF, Peixoto AJ. Blood pressure measurement in dialysis patients. Adv Chronic Kidney Dis 2004; 11:134-42. [PMID: 15216485 DOI: 10.1053/j.arrt.2004.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The best method and timing of blood pressure (BP) measurement in end-stage renal disease are subject to controversy. This issue is especially relevant in hemodialysis patients, where unique causes of inaccuracy may exist. The lack of standardization of BP measurement in the dialysis unit may lead to misdiagnosis, so close attention must be paid to technical methods to obtain BP. A composite of BP measurements over a period of 1 to 2 weeks rather than isolated readings should be used for guidance. Interdialytic BP monitoring with an ambulatory BP monitor is the most reproducible method and is thought to best represent BP in dialysis patients. If available, ambulatory BP is a useful tool to evaluate the quality of BP control in the interdialytic period. Alternative forms of BP measurement, such as home BP, 20-minute postdialysis BP, and short (3-hour to 4-hour) ambulatory blood pressure monitoring (ABPM), could prove useful when feasible or available. In this paper, we discuss the evidence regarding BP measurement in dialysis patients, new techniques under development, and recommendations for clinical practice.
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Haydar AA, Covic A, Jayawardene S, Agharazii M, Smith E, Gordon I, O'Sullivan H, Goldsmith DJA. Insights from ambulatory blood pressure monitoring: diagnosis of hypertension and diurnal blood pressure in renal transplant recipients. Transplantation 2004; 77:849-53. [PMID: 15077025 DOI: 10.1097/01.tp.0000115345.16853.51] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurate diagnosis of hypertension is essential in chronic kidney disease patients, as it is linked to increased left ventricular mass, stroke, cardiovascular mortality and morbidity, and progression to end-stage renal disease. Elevated blood pressure (BP) detected by ambulatory BP monitoring (ABPM) has been shown to be predictive of worse outcome in chronic kidney disease patients. Another predictor of worse outcome is diurnal BP variation, measured also by ABPM. In this study, the authors examined the relationship (concordance or discordance) between blood pressure measured by ABPM compared with daytime office BP, and also explored the predictors of diurnal variation in renal transplant recipients. METHODS All the patients who underwent renal transplantation and follow-up at the authors' institution from January 1998 to January 2003 were involved in this study (n=177) in addition to another randomly selected 64 patients that underwent transplantation before 1998. All patients had their ABPM performed according to previously described protocols at least 2 weeks after discharge from the hospital, dialysis-independent and with a functioning renal allograft. RESULTS The authors found a positive correlation between systolic BP (SBP) diurnal variation and age (r =0.263, P <0.0001), glomerular filtration rate (GFR) (r =-0.229, P <0.0001), cyclosporine trough (r =0.171, P =0.047), and ABPM-to-transplant interval (r =-0.133, P =0.039). After fitting a regression model, the authors found that only GFR (P <0.0001) and age (P =0.001) were independent predictors of SBP diurnal variation (r =0.357). Concordance rate between casual BP and ABPM was 80%, and by using casual BP, only 15% of hypertensive renal transplant patients would be erroneously diagnosed as normotensive. CONCLUSIONS The authors found that SBP diurnal variation is predicted independently by age and GFR, although it does correlate with cyclosporine trough and ABPM-to-transplant interval. In addition, the authors showed that ABPM is a more sensitive method for diagnosing hypertension than is sole reliance on office BP in renal transplant recipients.
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Affiliation(s)
- Ali A Haydar
- Renal and Transplantation Unit, Guy's Hospital, London, United Kingdom
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Haydar AA, Covic A, Agharazii M, Jayawardene S, Taylor J, Goldsmith DJA. Systolic blood pressure diurnal variation is not a predictor of renal target organ damage in kidney transplant recipients. Am J Transplant 2004; 4:244-7. [PMID: 14974946 DOI: 10.1046/j.1600-6143.2003.00326.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Elevated blood pressure and diurnal blood pressure variation detected by ambulatory blood pressure monitoring has been shown to be predictive of worse outcome in end-stage renal disease patients in small studies. What has been lacking is a large study to determine whether these ambulatory blood pressure monitoring (ABPM)-derived variables are predictors of worse outcome in renal transplant recipients. All the patients that underwent renal transplantation and follow up at this institution from January 1998 till October 2002 were involved in this study (n=177). All patients were followed up for at least 48 weeks. Last creatinine correlated positively with duration of dialysis (p=0.035, r=0.158), kidney-donor age (p<0.0001, r=0.377), early kidney function (p<0.0001, r=0.610, r=0.683), 24-h systolic blood pressure (SBP) load (p=0.002, r=0.228), and ABPM-derived pulse pressure (p<0.0001, r=0.269). However neither office blood pressure nor SBP diurnal variation were predictors of kidney outcome. Regression analysis showed that early kidney function was the only independent predictor of transplant outcome (p<0.0001). Systolic blood pressure diurnal variation, though an important predictor of target organ damage in chronic kidney disease patients, was not a predictor of renal transplant function in renal transplant recipients. Only early kidney function was an independent predictor of later serum creatinine.
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Affiliation(s)
- Ali A Haydar
- Renal and Transplantation Unit, Guy's Hospital, London, UK
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