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Diurnal Blood Pressure Changes One Year after Kidney Transplantation: Relationship to Allograft Function, Histology, and Resistive Index

Hani M. Wadei^*, Hatem Amer^*, Sandra J. Taler^*, Fernando G. Cosio^*, Matthew D. Griffin^*, Joseph P. Grande, Timothy S. Larson^*, Thomas R. Schwab^*, Mark D. Stegall and Stephen C. Textor^*

^* Department of Medicine, Division of Nephrology and Hypertension, Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, and Department of Surgery, Division of Transplantation Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota

Address correspondence to: Dr. Hani M. Wadei, Mayo Clinic Jacksonville, 4205 Belfort Road, Suite 1100, Jacksonville FL 32216. Phone: 904-296-9075; Fax: 904-296-5499; E-mail: wadei.hani{at}mayo.edu

Received for publication November 28, 2006. Accepted for publication February 20, 2007.

Loss of circadian BP change has been linked to target organ damage and accelerated kidney function loss in hypertensive patients with and without chronic kidney disease. Ambulatory BP–derived data from 119 consecutive kidney transplant recipients who presented for the first annual evaluation were examined in relation to allograft function, histology, and ultrasound findings. A total of 101 (85%) patients were receiving antihypertensive medications (median 2), and 85 (71%) achieved target awake average systolic BP (SBP) of <135 mmHg. A day–night change in SBP by 10% or more (dippers) was detected in 29 (24%). Dipping status was associated with younger recipient age, lack of diabetes, low chronic vascular score, and low resistive index. Nondippers and reverse dippers had lower GFR compared with dippers (P = 0.04). For every 10% nocturnal drop in SBP, GFR increased by 4.6 ml/min per 1.73 m² (R = 0.3, P = 0.003). Nondippers and reverse dippers were equally common in recipients with normal histology and in those with pathologic findings on surveillance biopsy. On multivariate analysis, percentage of nocturnal fall in SBP and elevated resistive index independently correlated with GFR. This study indicates that lack of nocturnal fall in SBP is related to poor allograft function, high chronic vascular score, and high resistive index irrespective of allograft fibrosis. Further studies are needed to determine whether restoration of normal BP pattern will confer better allograft outcome.

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673