Wystrychowski G, Kolonko A, Chudek J, Zukowska-Szczechowska E, Wiecek A, Grzeszczak W
Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Zabrze, Poland.
Transplant Proc. 2011 Oct;43(8):2922-5. doi: 10.1016/j.transproceed.2011.08.014.
High blood pressure and arterial stiffness contribute independently to cardiovascular mortality in uremic patients. High blood pressure is an established risk factor for chronic allograft nephropathy, recently named interstitial fibrosis/tubular atrophy (IF/TA). We sought to assess whether heart afterload determinants: arterial stiffness and vascular resistance or impedance accelerate kidney graft failure upon long-term observation.
Using a noninvasive method of blood pressure waveform analysis, (HDI/PulseWave/CR-2000), we studied 160 consecutive kidney transplant recipients, who were at least 3 months after transplantation, for systolic (SBP), diastolic, and mean blood pressure; pulse rate; systemic vascular resistance and impedance as well as large and small artery compliance. The associations of the hemodynamic parameters with relative increases in serum creatinine for every year of graft survival (ΔCreat) were assessed using multiple linear regression analysis. Relationships between systemic hemodynamics and kidney graft loss due to IF/TA were evaluated by Cox regression analysis, including serum creatinine, time after transplantation, delayed graft function, human leukocyte antigen mismatch, panel-reactive antibodies, cold ischemia time, donor age glomerular filtration rate as well as prescribed cardiovascular and immunosuppressive drugs.
Over 6.6±0.4 years of follow-up, excluding four noncompliant patients, 11 patients died and 32 lost their kidney grafts, including 25 due to IF/TA. ΔCreat (10.3%±22.0%/y) was independently and positively associated with the initial SBP (β=0.26; P=.001) and serum creatinine values (β=0.16; P=.04). The risk of graft loss due to IF/TA was greater among patients with an increased serum creatinine (relative risk [RR]=59.5 per nlog-unit increase; P<.001) or higher SBP (RR=51.1 per nlog-unit increase; P=.04). Besides SBP, no other hemodynamic parameter was associated with graft failure.
The rate of kidney graft function deterioration and risk of transplant loss due to IF/TA are not independently influenced by systemic arterial compliance, resistance, or impedance. SBP appears to be the key circulatory parameter independently affecting the progression of IF/TA, and should be a therapeutic target.
高血压和动脉僵硬度各自独立地导致尿毒症患者心血管死亡。高血压是慢性移植肾肾病（最近称为间质纤维化/肾小管萎缩，即IF/TA）的既定危险因素。我们试图评估心脏后负荷决定因素：动脉僵硬度和血管阻力或阻抗在长期观察中是否会加速肾移植失败。
我们使用一种无创血压波形分析方法（HDI/PulseWave/CR - 2000），研究了160例连续的肾移植受者，这些受者移植后至少3个月，测量其收缩压（SBP）、舒张压和平均血压；脉搏率；全身血管阻力和阻抗以及大动脉和小动脉顺应性。使用多元线性回归分析评估血流动力学参数与移植存活每年血清肌酐相对增加量（ΔCreat）之间的关联。通过Cox回归分析评估全身血流动力学与因IF/TA导致的肾移植丢失之间的关系，包括血清肌酐、移植后时间、移植肾功能延迟、人类白细胞抗原错配、群体反应性抗体、冷缺血时间、供体年龄、肾小球滤过率以及所使用的心血管和免疫抑制药物。
在6.6±0.4年的随访期间，排除4例不依从患者，11例患者死亡，32例失去肾移植，其中25例因IF/TA。ΔCreat（10.3%±22.0%/年）与初始SBP（β = 0.26；P = 0.001）和血清肌酐值（β = 0.16；P = 0.04）独立且呈正相关。血清肌酐升高（相对风险[RR] = 每nlog单位增加59.5；P < 0.001）或SBP较高（RR = 每nlog单位增加51.1；P = 0.04）的患者因IF/TA导致移植丢失的风险更大。除SBP外，没有其他血流动力学参数与移植失败相关。
肾移植功能恶化率和因IF/TA导致移植丢失的风险不受全身动脉顺应性、阻力或阻抗的独立影响。SBP似乎是独立影响IF/TA进展的关键循环参数，应成为治疗靶点。
