Department of Nephrology, University Hospital of Reims, Reims, France.
Clinical Research Unit, University Hospital of Reims, Reims, France.
Nephrol Dial Transplant. 2020 Sep 1;35(9):1619-1628. doi: 10.1093/ndt/gfaa104.
Moderate hyperhydration is often achieved in the early post-kidney transplantation period. Whether this strategy could lead to the development of intra-abdominal hypertension (IAH) has never been assessed so far. We aimed to study the incidence of IAH after kidney transplantation and its association with graft function recovery.
We conducted a prospective monocentric study among patients undergoing kidney transplantation at the University Hospital of Reims between May 2017 and April 2019. Intravesical pressure (IVP) was monitored every 8 h from Day 0 to 3.
A total of 107 patients were enrolled. Among 55 patients included in the analysis, 74.5% developed IAH. Body mass index >25 kg/m2 was associated with IAH development {odds ratio [OR] 10.4 [95% confidence interval (CI) 2.0-52.9]; P = 0.005}. A previous history of peritoneal dialysis was protective [OR 0.06 (95% CI 0.01-0.3); P = 0.001]. IAH Grades III and IV occurred in 30.9% of patients and correlated with higher Day 3 creatininaemia (419.6 ± 258.5 versus 232.5 ± 189.4 μmol/L; P = 0.02), higher delayed graft function incidence (41.2 versus 7.9%; P = 0.04), lower Kirchner index measured using scintigraphy (0.47 ± 0.09 versus 0.64 ± 0.09; P = 0.0005) and decreased Day 30 estimated glomerular filtration rate (35.8 ± 18.8 versus 52.5 ± 21.3, P = 0.05). IAH patients had higher fluid balance (P = 0.02). Evolution of IVP correlated with weight gain (P < 0.01) and central venous pressure (P < 0.001).
IAH is frequent after kidney transplantation and IAH Grades III and IV are independently associated with impaired graft function. These results question current haemodynamic objectives and raise for the first time interest in intra-abdominal pressure monitoring in these patients.
ClinicalTrials.gov identifier: NCT03478176.
在肾移植后的早期阶段，通常会实现适度的血容量过多。到目前为止，还从未评估过这种策略是否会导致腹腔内高压（IAH）的发生。我们旨在研究肾移植后 IAH 的发生率及其与移植物功能恢复的关系。
我们在 2017 年 5 月至 2019 年 4 月期间，在兰斯大学医院进行了一项前瞻性单中心研究。在第 0 天至第 3 天期间，每 8 小时监测一次膀胱内压（IVP）。
共纳入 107 例患者。在纳入分析的 55 例患者中，74.5%发生了 IAH。体重指数（BMI）>25kg/m2 与 IAH 的发生相关[比值比（OR）10.4（95%置信区间（CI）2.0-52.9）；P=0.005]。既往腹膜透析史具有保护作用[OR 0.06（95%CI 0.01-0.3）；P=0.001]。30.9%的患者发生了 IAH 分级 III 级和 IV 级，且与第 3 天血肌酐升高（419.6±258.5 比 232.5±189.4μmol/L；P=0.02）、更高的延迟移植物功能发生率（41.2%比 7.9%；P=0.04）、肾闪烁照相术测量的 Kirchner 指数降低（0.47±0.09 比 0.64±0.09；P=0.0005）和第 30 天估算肾小球滤过率下降（35.8±18.8 比 52.5±21.3，P=0.05）相关。IAH 患者的液体平衡更高（P=0.02）。IVP 的变化与体重增加（P<0.01）和中心静脉压（P<0.001）相关。
肾移植后 IAH 很常见，IAH 分级 III 级和 IV 级与移植物功能受损独立相关。这些结果对当前的血流动力学目标提出了质疑，并首次提出了在这些患者中监测腹腔内压的兴趣。
NCT03478176。
