Division of Nephrology & Hypertension, University of California Irvine Medical Center, Orange, CA, USA; Harold Simmons Center for Chronic Disease Research & Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
Clin Transplant. 2014 Feb;28(2):166-76. doi: 10.1111/ctr.12292. Epub 2013 Dec 24.
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.
Data from the Scientific Registry of Transplant Recipients were linked to the five-yr cohort of a large dialysis organization in the United States. We identified all dialysis patients who received a kidney transplant during this period. Unadjusted and multivariate adjusted predictors of transplant outcomes were examined.
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.
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.
先前的研究表明，透析患者的血压（BP）与死亡率之间存在 U 形关联。我们假设，在成功接受肾移植的透析患者中，这种关联同样存在于移植前血压与移植后结局之间。
我们将美国一家大型透析机构的五年队列数据与移植受者科学注册处的数据进行了关联。在此期间，我们确定了所有接受肾移植的透析患者。我们检查了移植结局的未调整和多变量调整预测因素。
在我们的研究中，共有 13881 名患者年龄为 47±14 岁，其中 42%为女性。移植前收缩压与移植后死亡率之间无关联，但在透析后收缩压较低的患者中，风险呈下降趋势。与透析前舒张压 70 至<80mmHg 的患者相比，透析前舒张压<50mmHg 的患者移植后死亡风险较低（风险比[HR]：0.74，95%CI：0.55-0.99）。然而，与透析后舒张压 70 至<80mmHg 的患者相比，透析后舒张压≥100mmHg 的患者死亡风险更高（HR：3.50，95%CI：1.57-7.84）。此外，非常低的（舒张压<50mmHg 和收缩压<110mmHg）移植前血压与较低的移植后失功风险相关。
透析后收缩压较低和透析前舒张压较低与移植后死亡风险降低相关，而透析后舒张压非常高与肾移植受者死亡率升高相关。肾移植前透析患者的血压变化可能对移植后结局有影响，值得进一步研究。
