Auñón Pilar, Cavero Teresa, García Ana, González Jorge, Andrés Amado
Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
Department of Nephrology. Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Kidney Int Rep. 2024 Mar 18;9(6):1742-1751. doi: 10.1016/j.ekir.2024.03.012. eCollection 2024 Jun.
Persistent chronic hypotension affects 5-10% of dialysis patients. It seems to be reversible after receiving a functioning graft, but data regarding its influence on transplant outcomes are scarce. We analyze the evolution of patients with chronic hypotension in dialysis who undergo kidney transplantation at our center.
A retrospective observational study was conducted. Sixty-six patients with chronic hypotension (defined as systolic blood pressure ≤ 100 mm Hg at the time of transplantation) were identified. A control group of 66 non-hypotensive patients was assigned. The evolution of both groups was compared.
Hypotensive patients had higher rates of primary non-function (18.2% vs. 6.1%; = 0.03) mainly due to venous thrombosis of the allograft, worse renal function at the end of follow-up (eGFR of 35 mL/min/1.73 m vs 48 mL/min/1.73 m, = 0.001) but there was no statistical difference in graft survival after censoring for primary non-function. After multivariable adjustment, chronic hypotension remained an independent predictor factor for graft failure (adjusted HR of 2.85; 95% CI: 1.24-6.57; = 0.014). Use of vasoactive drugs and anticoagulation in hypotensive patients was associated with 7.1% of venous graft thrombosis compared to 17.3% in those with no intervention ( = 0.68). Receiving a functioning graft implied blood pressure normalization in patients with chronic hypotension.
Chronic hypotension in dialysis has a negative impact on short-term kidney transplant outcomes but a lower impact on long-term results. It is reversible after receiving a functioning graft. Identifying this subgroup of patients seems crucial to implement measures aimed at improving transplant results.
持续性慢性低血压影响5%至10%的透析患者。在接受功能正常的移植物后，这种情况似乎是可逆的，但关于其对移植结果影响的数据却很稀少。我们分析了在我们中心接受肾移植的透析慢性低血压患者的病情演变。
进行了一项回顾性观察研究。确定了66例慢性低血压患者（定义为移植时收缩压≤100 mmHg）。分配了一个由66例非低血压患者组成的对照组。比较了两组的病情演变。
低血压患者的原发性无功能发生率较高（18.2%对6.1%；P = 0.03），主要原因是同种异体移植物静脉血栓形成，随访结束时肾功能较差（估计肾小球滤过率为35 mL/min/1.73 m²对48 mL/min/1.73 m²，P = 0.001），但在对原发性无功能进行审查后，移植物存活率没有统计学差异。经过多变量调整后，慢性低血压仍然是移植物失败的独立预测因素（调整后的风险比为2.85；95%置信区间：1.24 - 6.57；P = 0.014）。与未进行干预的患者相比，低血压患者使用血管活性药物和抗凝治疗导致静脉移植物血栓形成的比例为7.1%，而未进行干预的患者为17.3%（P = 0.68）。接受功能正常的移植物意味着慢性低血压患者的血压恢复正常。
透析中的慢性低血压对肾移植短期结果有负面影响，但对长期结果的影响较小。接受功能正常的移植物后，这种情况是可逆的。识别这一亚组患者对于实施旨在改善移植结果的措施似乎至关重要。
