Is There an Optimal Arterial Pressure Level in Patients with End-Stage Chronic Renal Failure Before and After Kidney Transplantation?

Arterial hypertension occurs in 100% cases of end-stage chronic renal failure (ESCRF). It significantly worsens ESCRF and provokes cardiovascular complications. The presence of uncontrolled arterial hypertension after kidney transplantation becomes a determining factor deteriorating the prognosis of patients.

The aim of the investigation was to define the changes of arterial pressure (AP) in patients with end-stage chronic renal failure before and after kidney transplantation, along with antihypertensive therapy, and determine the most safe arterial pressure levels, with the kidney continuing its optimal functioning.

Materials and Methods. The study involved 31 patients (16 male, 15 female patients), who underwent kidney transplantation for ESCRF. The study included the kidney functioning monitoring for a month after the transplantation (5 examinations), and the analysis of hemodynamic, biochemical indices, with transplant function definition. With the aim of achieving optimal AP before and after kidney transplantation, we actively titrated antihypertensive medicinal preparations and studied the functional state of a transplant.

Results. Arterial hypertension was diagnosed in 100% of patients before transplantation; its level decreasing, on average, to the next lower order. In early postoperative period on day 7±1 the patients’ systolic AP decreased from 159.4±13.2/98.7±5.6 to 137.1±9.4/84.8±8.1 mm Hg (p<0.001), and by the time of discharge its level averaged 127.9±9.2/81.1±6.9 mm Hg. Before hospitalization the patients took on average 1.9±0.2 basic medications, on discharge — 2.9±0.1. The indices of creatinine and urea levels, glomerular filtration rate (GFR) and proteinuria consistently normalized. Postoperative intensity of systemic AP decrease had no effect on GFR levels in patients with ESCRF: GFR insignificantly increased in higher systolic AP: R²=0.082; p=0.09; R^{^2}=0.083; p=0.23. A month after kidney transplantation AP level appeared to be optimal in the range of 115–130 mm Hg, and with such AP values GFR indices significantly grew (R²=0.25; p=0.035; R^{^2}=0.3; p=0.027). Diastolic AP level had no significant effect on transplant function.

Conclusion. In 100% cases, ESCRF patients have a syndrome of II or III degree arterial hypertension. After kidney transplantation there is an independent AP increase by one-two AP increase degrees. Intensive AP decrease in ESCRF patients before transplantation results in GFR decline. After transplantation there is GFR increase with an active decrease of systolic AP in the range of 115–130 mm Hg.

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Fomin I.V., Ostanina А.А., Polyakov D.S., Lipatov K.S. Is There an Optimal Arterial Pressure Level in Patients with End-Stage Chronic Renal Failure Before and After Kidney Transplantation?. Sovremennye tehnologii v medicine 2014; 6(2): 53