Kim Chang Seong, Oh Tae Ryom, Suh Sang Heon, Choi Hong Sang, Bae Eun Hui, Ma Seong Kwon, Jung Jin Hyung, Kim Bongseong, Han Kyung-Do, Kim Soo Wan
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Front Cardiovasc Med. 2023 Jul 14;10:1185001. doi: 10.3389/fcvm.2023.1185001. eCollection 2023.
Hypertension is highly prevalent in patients with kidney transplantation caused by transplantation-related immunologic or non-immunologic risk factors. However, whether a strict definition of hypertension (≥130/80 mmHg) and subdivided blood pressure (BP) groups are associated with an increased risk of graft failure after kidney transplantation using a nationwide large cohort study are still unknown.
Using Korean National Health Insurance Service data, we included 14,249 patients who underwent kidney transplantation from 2002 to 2016. Patients were categorized into five BP groups according to the 2021 Kidney Disease: Improving Global Outcomes practice guidelines for BP management: normal BP (<120/80 mmHg), elevated BP (120-129/ < 80 mmHg), incident hypertension (≥130/80 mmHg), and controlled or uncontrolled hypertension with anti-hypertensive medications.
The primary outcome was graft failure, which occurred in 1934 (13.6%) participants during the 6-year follow-up. After adjusting for covariates, hypertension was associated with a higher risk of graft failure [Adjusted hazard ratio (AHR), 1.70; 95% confidence interval (CI), 1.48-1.96)] than no-hypertension. The AHR for graft failure was the highest in patients with uncontrolled hypertension (AHR, 2.13; 95% CI, 1.80-2.52). The risk of graft failure had a linear relationship with systolic and diastolic BP, and pulse pressure.
In this nationwide population-based study, hypertension ≥130/80 mmHg based on the 2021 KDIGO BP guidelines in kidney transplantion recipients, and elevated systolic and diastolic BP, and pulse pressure were associated with the risk of developing graft failure in kidney transplant recipients.
由移植相关免疫或非免疫危险因素引起的高血压在肾移植患者中非常普遍。然而，使用全国性大样本队列研究来探究严格的高血压定义（≥130/80 mmHg）和细分的血压（BP）组是否与肾移植后移植失败风险增加相关，目前仍不清楚。
利用韩国国民健康保险服务数据，我们纳入了2002年至2016年期间接受肾移植的14249例患者。根据2021年《改善全球肾脏病预后组织（KDIGO）血压管理临床实践指南》，将患者分为五个血压组：正常血压（<120/80 mmHg）、血压升高（120 - 129/<80 mmHg）、新发高血压（≥130/80 mmHg）以及使用抗高血压药物控制或未控制的高血压。
主要结局是移植失败，在6年随访期间，1934例（13.6%）参与者出现了移植失败。在调整协变量后，高血压患者移植失败的风险高于非高血压患者[调整后风险比（AHR）为1.70；95%置信区间（CI）为1.48 - 1.96]。移植失败的AHR在未控制高血压的患者中最高（AHR为2.13；95%CI为1.80 - 2.52）。移植失败风险与收缩压、舒张压和脉压呈线性关系。
在这项基于全国人群的研究中，根据2021年KDIGO血压指南，肾移植受者中血压≥130/80 mmHg以及收缩压、舒张压升高和脉压升高与移植失败风险相关。
