[PP.22.08] BLOOD PRESSURE AS A MARKER OF THE RISK OF DEATH AND DIALYSIS IN RENAL TRANSPLANT RECIPIENTS NOT TREATED FOR HYPERTENSION

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Abstract

Objective:

In renal transplantation, hypertension is a risk factor for death and dialysis, and most patients are treated for hypertension. However, whether blood pressure (BP) in untreated patients stable conditions early after transplantation remains a risk factor is not established.

Design and method:

During the 1985–2014 period, 1797 patients received a kidney graft in the Tours University Hospital, and 1768 had a functional graft at the 12-month visit following transplantation. Among them, 320 patients had usualy normal BP and did not receive any antihypertensive drug during the first year. We analyzed the association between BP and the risks of death and dialysis in this subgroup.

Results:

Patients were 42.5 ± 17.9, 55.6% were male, 10.0% were diabetics; blood pressure was 129.8 ± 16.8/76.6 ± 11.3 mmHg. Proteinuria was 0.24 ± 0.70 g/day, and eGFR was 67.8 ± 37.3 ml/min/1.73m2. Office BP was < 140/90 mmHg in 66.9%, and was betweeen 140–159/90–99 mmHg in 25.3% at the 12-month visit.

Results:

During follow-up (6.8 years, range: 0.1–29), 34 patients died and 71 returned to dialysis.

Results:

Systolic blood pressure at the 12 months was associated with a greater risk of death (HR per 10 mmHg: 1.33 [1.11–1.58], P = 0.0017; cardiovascular death: 1.63 [1.19–2.24], P = 0.0024) and dialysis (HR: 1.16 [1.02–1.32], P = 0.0205). The risk of all-cause and cardiovascular death associated with BP remained significant even after adjustment on eGFR, but not after full adjustment on age, sex and GFR.

Conclusions:

Early elevated Blood pressure early after transplantation is a marker of the risk of all-cause and cardovascular death and dialysis in renal transplant recipients even when they have usual normal blood pressure and are not treated for hypertension. Attention should be focused to blood pressure reduction in this population early after transplantation.

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