Figure - available from: Frontiers in Medicine
This content is subject to copyright.
Selected common factors contributing to post-transplant hypertension during three different periods.
Source publication
Hypertension is one of the most common cardiovascular co-morbidities after successful kidney transplantation. It commonly occurs in patients with other metabolic diseases, such as diabetes mellitus, hyperlipidemia, and obesity. The pathogenesis of post-transplant hypertension is complex and is a result of the interplay between immunological and non...
Similar publications
Comparative efficacy and safety of renal denervation (RDN) interventions for uncontrolled (UH) and resistant hypertension (RH) is unknown. We assessed the comparative efficacy and safety of existing RDN interventions for UH and RH. Six search engines were searched up to 1 May 2020. Primary outcomes were mean 24-h ambulatory and office systolic bloo...
Citations
... Patients may experience changes in their vital signs due to the problems and stress that they might experience in the postoperative period. Conditions such as surgical intervention, anesthesia, medications administered after transplantation, inflammatory process, pain, nausea, vomiting, a decrease in activity, anxiety, and social isolation may also cause fatigue in patients [4,6,8]. Complementary and alternative therapeutic techniques are used by nurses to manage the change in vital signs and fatigue found in patients. ...
Purpose
Multiple effective nursing interventions are needed to manage deviations from normal vital signs and fatigue experienced by kidney transplant patients. In this study, we investigated the effect of progressive muscle relaxation (PMR) exercises on vital signs and fatigue in kidney transplant patients.
Method
We conducted a randomized controlled experimental study with 52 patients (intervention = 26, control = 26) who underwent kidney transplantation at a university hospital in Turkey and met the inclusion criteria. The “Descriptive Characteristics Form”, “Vital Signs Monitoring Form”, and “Fatigue Severity Scale” were used to record data on the patients. Then, the patients in the intervention group (baseline assessment) were trained to perform PMR exercises, asked to practice, and followed up (first follow-up). Patients were recommended to perform PMR exercises for 20 min every day for four weeks. The second follow-up in the second week after discharge and the third follow-up at the end of the fourth week were performed in the outpatient clinic.
Results
We found that the pulse rate, body temperature, and arterial blood pressure decreased over time and oxygen saturation increased in the patients of the intervention group. The PMR exercises decreased fatigue in these patients. The arterial blood pressure and oxygen saturation values differed significantly across different time points among the patients in the control group. The difference in the scores of fatigue severity between the pre-follow-up and the third follow-up in the control group was not significant.
Conclusion
PMR exercises were found to be an effective nursing intervention in regulating vital signs and reducing fatigue in renal transplant patients.
... Hypertension is highly prevalent among patients with ESKD or advanced chronic kidney disease (CKD), with post-transplant rates ranging 24-90% [28]. Several risk factors have been associated with a higher likelihood of post-transplant hypertension [28]. ...
... Hypertension is highly prevalent among patients with ESKD or advanced chronic kidney disease (CKD), with post-transplant rates ranging 24-90% [28]. Several risk factors have been associated with a higher likelihood of post-transplant hypertension [28]. These factors include pre-existing hypertension, an elevated body mass index, male gender, delayed graft function, older age of the organ donor, and the side effects of medications such as calcineurin inhibitors (CNIs) and corticosteroids [28]. ...
... Several risk factors have been associated with a higher likelihood of post-transplant hypertension [28]. These factors include pre-existing hypertension, an elevated body mass index, male gender, delayed graft function, older age of the organ donor, and the side effects of medications such as calcineurin inhibitors (CNIs) and corticosteroids [28]. Other factors include acute allograft rejection, recurrence of disease in the transplanted kidney, and renal artery stenosis [28]. ...
Patients with kidney transplants have a significant co-morbidity index, due to a high number of pre-existing conditions and use of immunosuppression medications. These patients are at higher risk of developing conditions such as hypertension, dyslipidemia, post-transplant diabetes, cardiovascular events, and anemia. Moreover, they are particularly susceptible to infections such as urinary tract infections or pyelonephritis, cancers, and gastrointestinal complications such as diarrhea, which in turn may be attributed to medication adverse effects or infectious causes. Along with these concerns, meticulous management of electrolytes and allograft function is essential. Prior to prescribing any new medications, it is imperative to exercise caution in identifying potential interactions with immunosuppression drugs. This review aims to equip primary care practitioners to address these complex issues and appropriate methods of delivering care to this rapidly growing highly susceptible group.
... The pathogenesis of post-transplantation hypertension is complex, and is a result of the interaction between immunological and non-immunological factors (10). Recommended target blood pressure is <130/80 mmHg (30). In our study, 59% patients had hypertension, and 60% a year after the treatment for MS. ...
Aim To analyse prevalence of metabolic syndrome (MS) in kidney transplant recipients at the University Clinical Centre Tuzla in Bosnia and Herzegovina (B&H), and determine effects of a modern drug therapy in achieving target metabolic control in kidney transplant patients. Methods A single-centre prospective study that included 142 kidney transplant patients over one year follow-up period was conducted. Patient data were collected during post-transplant periodical controls every 3 months including data from medical records, clinical examinations and laboratory analyses. Results Out of 142 kidney transplant patients, MS was verified in 85 (59.86%); after a pharmacologic treatment MS frequency was decreased to 75 (52.81%). After a one-year period during which patients were receiving therapy for MS, a decrease in the number of patients with hyperlipoproteinemia, decrease in average body mass index (BMI), glycemia and haemoglobin A1C (HbA1C) were observed. Hypertension did not improve during this period, which can be explained by transplant risk factors in the form of immunosuppressive drugs and chronic graft dysfunction. Conclusion A significant reduction in components of the metabolic syndrome after only one year of treatment was recorded, which should be the standard care of kidney transplant patients.
... Las patologías cardiovasculares, siendo su mayor representante la hipertensión arterial en valores donde la guía de american collage of cardiology considero que una presión arterial adecuada para las personas trasplantadas entra en los valores de ≥130/80 es otra de las complicaciones que se presenta postrasplante renal presentando una prevalencia a nivel mundial del 70% al 90%, siendo esta una de las principales causas de muerte en los pacientes que hayan sido trasplantados (53). ...
... Hipertensión arterial postrasplante: desarrollan hipertensión posterior a la cirugía, representa el 19 % de los casos (53). ...
La enfermedad renal en etapa terminal tiene como mejor método el trasplante dando una mejor calidad de vida al paciente, pero para esto es necesario aclarar cuáles son las complicaciones tempranas que este puede presentar postrasplante puesto que es necesario actuar de manera oportuna para evitar el fallo del injerto o incluso a la muerte del receptor, el objetivo del presente trabajo es describir las complicaciones tempranas del postrasplante renal, relacionadas a la sobrevida del paciente, se han podido observar complicaciones relacionadas también al uso de los inmunosupresores causando daños neurológicos y dando paso a infecciones, otras complicaciones también están relacionadas al sistema cardiovascular, gastrointestinal y en muy raras ocasiones se han descrito afectación a la cavidad bucal. Para la presente revisión bibliográfica se utilizó la biblioteca virtual de la universidad católica de cuenca en donde se tuvo acceso a la base de datos como pubmed, web of scince, scopus y se utilizó artículos científicos sin restricción de idioma y con cinco años de antigüedad que entren dentro del Q1 a Q4 Se concluyo que las complicaciones más frecuentes que pudimos observar en la investigación fueron las infecciosas y estas presentaron tener estrecha relación con la pérdida o falla del injerto e incluso con el fallecimiento del paciente en aproximadamente un 50% dependiendo cual sea el agente patógeno que haya infectado al injerto
... We typically use calcium channel blockers (nifedipine or amlodipine) as a first-line antihypertensive treatment post-KTx, followed by a beta blocker (labetalol, or carvedilol). Hydralazine, clonidine, alpha blockers, and angiotensin-converting enzyme inhibitors are used respectively as add-on therapies [19,20]. During the study period, physicians at our center followed the KDOQI-US 2012 guidelines and any changes to the antihypertensive management were the choice of the treating physician at each clinic visit. ...
Introduction:
Uncontrolled hypertension after kidney transplantation (KTx) is very common and is associated with significant morbidity. However, studies that assess its incidence and risk factors are limited and outdated in the Middle East.
Methods:
This is a single-center retrospective study of KTx recipients (KTRs) in our center between January 2017 and May 2020 with a 12-month follow-up period. The target of hypertension treatment during the time of this study was <140/90 mmHg, according to the published guidelines. We divided patients according to their blood pressure (BP) control at one year into two groups: controlled blood pressure (cBP) (<140/90) and uncontrolled blood pressure (uBP) ( ≥ 140/90). We studied the association between cBP and patients' demographics, baseline cardiovascular risk factors, and changes in their metabolic and cardiovascular profile during the first 12 months after KTx.
Results:
A total of 254 KTRs were included. 79.2% developed post-KTx hypertension, 74% were ≥ 30 years, 58% were men, and 80% were living-donor KTRs. The renal replacement modality among our patients/sample before KT was hemodialysis in 78.4%, peritoneal dialysis in 11.5%, and 10.1% underwent pre-emptive transplantation. At one year, 76 (29.9%) KTRs did not attain the target BP goal. Systolic BP decreased from baseline to 12 months by 13±24 mmHg in the cBP group and increased by 8.7±21 mmHg in the uBP group (p<0.001). Additionally, diastolic BP decreased by 8.5±16.9 mmHg in the cBP group and increased by 2.3±18.8 mmHg in the uBP group (p<0.001). Factors associated with uBP included age (47 vs 41 years, p=0.008) and diabetes mellitus (p=0.012). Contrarily, gender, dialysis vintage, preemptive transplantation, type of dialysis (hemodialysis vs peritoneal dialysis), type of transplant (living donor kidney transplant vs deceased donor kidney transplant), and smoking were not different among the two groups. There were no significant differences between the two groups in regard to creatinine change from baseline, rate of rejection, weight change, A1C change, new onset diabetes post-transplant, LDL change, PTH change from baseline, and persistent hyperthyroidism. However, higher BMI at 12 months was associated with a higher incidence of uBP (27.2±5.9 vs 29.2±5.4, p=0.013). Using multivariate analysis, we found that serum creatinine at 12 months was the only predictor of uBP (OR=1.005 (1-1.011), p=0.036).
Conclusion:
At one-year post renal transplantation, about one-third of KTRs had uBP despite multiple antihypertensive medications. SBP and DBP significantly trended upwards after transplantation in uBP patients, whereas SBP and DBP significantly trended downwards after transplantation in cBP patients. Further controlled, prospective studies in the Saudi population are needed to confirm these findings.
... Currently, kidney transplantation is widely and successfully used, and there are numerous studies on this procedure. [1][2][3][4] Acute rejection is the most common transplantation failure within 3 months after kidney transplantation. It is also referred to as acute cellular rejection due to cellular immune mechanism in the early stages. ...
Objective
To investigate the changes in the proportion of peripheral blood lymphocytes and the expression of HLA II molecules in lymphocytes during acute rejection after renal transplantation.
Methods
Thirty-five patients who had undergone renal transplantation were selected. Eighteen patients with clinical and pathological confirmed acute rejection were selected as the test group, and twelve patients without clinical acute rejection symptoms were selected as the control group. Flow cytometry analysis was used to determine the proportion of peripheral blood lymphocytes. The mRNA and protein expression of HLA II molecules on peripheral blood lymphocytes were detected using real-time fluorescence quantification and immunoblotting, respectively.
Results
The proportion of T lymphocytes, B lymphocytes, and CD4CD8 double positive T cells in the Control Group were 67.48% ± 5.35%, 10.82% ± 1.26%, and 0.88% ± 0.06%, respectively, and in the Test Group were 87.52% ± 6.28%, 3.36% ± 0.26%, and 0.34% ± 0.03%, with a significant difference respectively. The mRNA and protein expressions of HLA II molecules of peripheral blood B lymphocytes in the control group were significantly higher that these in the test group.
Conclusion
The proportion of peripheral blood T lymphocytes, B lymphocytes, CD4CD8 double positive T cells, and the expression of HLA II molecules of peripheral blood lymphocytes can all indicate the occurrence of acute renal transplantation rejection, which were exceedingly useful to clinicians in judging the acute rejection of renal transplantation in the early stages.
... KTRs with DTC HTN had a higher pre-KTx BMI and at 12 months post-KTx but both groups gained weight in a similar fashion. Preventing and treating obesity among KTRs may reduce their antihypertensive medications burden [43,44] . ...
Background:
There are limited data on why some kidney transplant (KTx) recipients (KTRs) have “difficult-to- control (DTC) hypertension” requiring ≥2 antihypertensive medications while others require less antihypertensive medications post-KTx.
Methods:
We reviewed the pre-KTx cardiovascular (CV) imaging, and the changes of CV risk factors during the first-year post-KTx. We divided patients according to the number of their blood pressure (BP) medications at one year into two groups: requiring ≤1 and requiring ≥2 medications (DTC hypertension). The target BP during the time of this study was <140/90 mmHg.
Results:
245 KTRs were included with an average age of 43.2. 56.3% were male and 79.2% were living donor KTRs. Pre-emptive KTx was 6.5%, previous coronary artery disease was 12.7%, diabetes and smoking 40.8% and 9%, respectively. 38% of the patients had DTC HTN. Risk factors were age (P<0.01), pre-KTx hypertension (P<0.01) and diabetes mellitus (P<0.01). Dialysis vintage, type of dialysis, type of KTx, and smoking were not different between the groups.
Patients with abnormal pre-KTx CV imaging, including abnormal ejection fraction <55% (P=0.03), abnormal wall motion on echocardiography (P<0.01), abnormal perfusion stress test (P<0.01), higher calcium scoring (P<0.01), abnormal cardiac catheterization (P<0.01), or higher degree of calcifications on CT of pelvic arteries (P<0.01) were at higher risk of DTC hypertension. Post-KTx factors including rejection, change in serum creatinine and weight, A1c, new-onset diabetes post-KTx, and persistent hyperparathyroidism were not different between the groups.
Multivariate analysis revealed associations with age (aOR=1.027), male gender (aOR=2.057), baseline DM (aOR=2.065), baseline HTN (aOR=2.82), and use of ≥2 antihypertensive medications at one-month post-KTx (aOR=6.146).
Conclusion:
At one year post transplantation, about a third of KTRs required had DTC HTN. These patients were more likely to be older, males, diabetics, previously hypertensive, on ≥ 2 HTN medications at one-month post-KTx, and have abnormal baseline pre-transplant CV imaging.
... In Africa, hypertension and its complications including renal dysfunction have been reported and constitute a major factor in the high morbidity and mortality among adults in the sub-Saharan Africa [9]. Studies have also proposed that higher blood pressure (systolic blood pressure ≥ 140 mmHg; diastolic blood pressure ≥ 90 mmHg) predicts more liberal development of nephropathy, and proteinuria is a well-recognized major risk factor for the development of nephropathy in people with essential hypertension [10]. It is unknown how prevalent kidney disease is in the Ghanaian population but Osafo et al. [11] posited that the prevalence of chronic kidney disease (CKD) was 46.9% among hypertensive individuals in Ghana. ...
Background
Renal failure is one of the most serious vascular effects of hypertension. For better therapy and prevention of complications, early kidney disease identification in these patients is absolutely essential. However, current studies have proposed plasma Neutrophil Gelatinase Associated Lipocalin (pNGAL) to be a better biomarker comparative to serum creatinine (SCr). This study assessed the diagnostic utility of plasma neutrophil gelatinase-associated lipocalin (pNGAL) as a biomarker for early nephropathy diagnosis in hypertensive individuals.
Methods
This hospital-based case–control study comprised 140 hypertensives and 70 healthy participants. A well-structured questionnaire and patient case notes were used to document relevant demographic and clinical information. 5 ml of venous blood sample was taken to measure fasting blood sugar levels, creatinine, and plasma NGAL levels. All data were analyzed using the Statistical Package for Social Sciences (SPSS release 20.0, copyrite©SPSS Inc.) and a p -value < 0.05 was considered statistically significant.
Results
In this study the plasma neutrophil gelatinase-associated lipocalin (NGAL) levels were significantly higher in cases compared to controls. Hypertensive cases also had significantly higher waist-circumference compared to the control group. The median fasting blood sugar level was significantly higher in cases compared to controls. This study established the use of Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft and Gault formula (CG) as the most accurate predictive equations for assessing renal dysfunction. The threshold for NGAL above which renal impairment can be assessed was found to be 109.4 ng/ml (sen-91%, spec. – 68%), 120 ng/ml (sen- 100%, spec- 72%) and 118.6 ng/ml (sen- 83%, spec- 72%) for MDRD, CKD-EPI and CG equations respectively. The prevalence of CKD was 16.4%, 13.6% and 20.7% respectively using the MDRD, CKD-EPI and CG.
Conclusion
From this study, pNGAL is a better indicator of kidney impairment in the early stages of CKD as compared with sCr in general hypertensive population.
... In Africa, hypertension and its complications including renal dysfunction have been reported and constitute a major factor in the high morbidity and mortality among adults in the sub-Saharan Africa [9]. Studies have also proposed that higher blood pressure (systolic blood pressure ≥ 140 mmHg; diastolic blood pressure ≥ 90 mmHg) predicts more liberal development of nephropathy, and proteinuria is a well-recognized major risk factor for the development of nephropathy in people with essential hypertension [10]. It is unknown how prevalent kidney disease is in the Ghanaian population but Osafo et al. [11] posited that the prevalence of chronic kidney disease (CKD) was 46.9% among hypertensive individuals in Ghana. ...
... Delayed graft function While diuretics are to be used cautiously following transplantation, loop diuretics can be used to manage hypertension following transplantation. [27] Haematocrit should be maintained between 27 and 30%. If a decision to perform transfusion is made, then packed red cells that are leukocyte depleted and irradiated should be used to prevent antibody-mediated rejection and graft versus host disease, respectively. ...
Organ transplantation has undergone remarkable revolution in the last two decades and offers a scope for survival amongst patients with end-stage organ failure. Along with availability of advanced surgical equipment and haemodynamic monitors, minimally invasive surgical techniques have emerged as options for surgery both amongst the donors and recipients. Newer trends in haemodynamic monitoring and expertise in ultrasound guided fascial plane blocks have changed the management in both donors and recipients. The availability of factor concentrates and point-of-care tests for coagulation have allowed optimal and restrictive fluid management of patients. Newer immunosuppressive agents are useful in minimising rejection following transplantation. Concepts on enhanced recovery after surgery have allowed early extubation, feeding and shorter hospital stay. This review gives an overview of the recent progress in anaesthesia for organ transplantation.
