Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA.
William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.
Clin Transplant. 2021 Jun;35(6):e14293. doi: 10.1111/ctr.14293. Epub 2021 Mar 30.
The medium- to long-term outcomes of living kidney donors with hypertension compared to normotensive donors are not well understood, especially with the recent changes in hypertension guidelines.
We studied a cohort of 950 living kidney donors using different definitions of hypertension based on either ≥140/90 or ≥130/80 mmHg thresholds and based on either office or ambulatory blood pressure readings. Microstructural features on kidney biopsy at the time of donation were compared using different definitions of hypertension.
After adjusting for years of follow-up, age, sex, and baseline eGFR, hypertension (by any definition) did not significantly predict an eGFR < 45 ml/min/1.73 m at a median follow-up of 10 years postdonation, though there was a borderline association with ambulatory blood pressure ≥ 130/80 mmHg predicting a 40% decline in eGFR (OR = 1.53, 1.00-2.36; p = .051). Proteinuria was predicted by office blood pressure ≥ 140/90 mmHg and by nondipper profile on nocturnal ambulatory blood pressure measurements. At the time of donation, larger glomeruli and arterial hyalinosis on biopsy were associated with hypertension defined by either ≥140/90 or ≥130/80 mmHg (by office or ambulatory measurements). Nocturnal nondipper status was associated with larger glomeruli size but not arteriolar hyalinosis when compared to dippers.
In programs that accept donors with controlled hypertension, various definitions of hypertension are associated with histological findings in the donated kidney, but none predict a clinically significant decline in kidney function 10 years after donation. These data support allowing healthy individuals with controlled hypertension to donate a kidney. However, donors with office hypertension (≥140/90 mmHg) and nondippers (regardless of hypertension status) are at greater long-term risk for proteinuria, and particularly for these donors, longer follow-up is warranted.
与血压正常的供体相比，患有高血压的活体肾脏供体的中-长期预后尚不清楚，尤其是在高血压指南最近发生变化的情况下。
我们根据≥140/90 或≥130/80mmHg 阈值和诊室或动态血压读数，使用不同的高血压定义，对 950 名活体肾脏供体进行了研究。根据不同的高血压定义，比较了供体时肾脏活检的微观结构特征。
在校正随访年限、年龄、性别和基线 eGFR 后，任何定义的高血压（均未）显著预测捐赠后中位 10 年的 eGFR<45ml/min/1.73m，尽管动态血压监测≥130/80mmHg 与 eGFR 下降 40%存在边缘关联（OR=1.53，1.00-2.36；p=0.051）。蛋白尿与诊室血压≥140/90mmHg 和夜间动态血压测量的非杓型有关。在供体时，活检中较大的肾小球和动脉玻璃样变性与≥140/90 或≥130/80mmHg 定义的高血压（通过诊室或动态测量）相关。与夜间杓型相比，非杓型状态与更大的肾小球体积有关，但与小动脉玻璃样变性无关。
在接受控制良好的高血压供体的项目中，各种高血压定义与供体肾脏的组织学发现相关，但没有一种定义能预测捐赠后 10 年肾功能出现临床显著下降。这些数据支持允许健康的高血压患者捐献肾脏。然而，有诊室高血压（≥140/90mmHg）和非杓型的供体（无论高血压状态如何）蛋白尿的长期风险更高，特别是对于这些供体，需要更长时间的随访。
