Blood pressure monitoring following kidney transplantation in children: a comparison of invasive and noninvasive measurements using Doppler as a benchmark technique,Pediatric Nephrology

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Blood pressure monitoring following kidney transplantation in children: a comparison of invasive and noninvasive measurements using Doppler as a benchmark technique
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2022-08-01 , DOI: 10.1007/s00467-022-05691-2
Eytan Kaplan _{1,

2} , Gili Kadmon _{1,

2} , Elhanan Nahum _{1,

2} , Hadas Alfandary _{2,

3} , Orly Haskin _{2,

3} , Avichai Weissbach _{1,

2}

Affiliation

Background

Blood pressure (BP) monitoring following pediatric kidney transplantation is essential for optimizing graft perfusion. Differences between invasive BP and noninvasive BP (NIBP) measurements are sometimes considerable. We aimed to assess agreement between invasive BP and NIBP in pediatric patients after kidney transplantation and compare with measurements obtained by systolic Doppler with manual sphygmomanometer as a reference technique.

Methods

A prospective, observational cohort study, of children aged 18 years or younger, admitted immediately following kidney transplantation to the pediatric intensive care unit of a tertiary, university-affiliated medical center, between May 2019 and June 2021.

Results

Eighty-two paired simultaneous measurements of invasive BP, NIBP, and Doppler BP in 18 patients were compared. Patients were significantly hypertensive, with mean systolic NIBP above the 95th percentile (96 ± 6%). Systolic invasive BP measurements were significantly higher than NIBP (149 ± 20 vs. 136 ± 15 mmHg, p < 0.001). Substantial differences (≥ 20 mmHg) were found in 23% (95% CI 15–34%). Similar disagreement was found between systolic invasive and Doppler BP (150 ± 23 and 137 ± 17 mmHg, respectively, p < 0.001). In contrast, systolic NIBP was in good agreement with Doppler BP (135 ± 17 and 138 ± 18, respectively, p = 0.27). A moderate to strong correlation was found between higher systolic invasive BP and the difference to systolic Doppler BP (Spearman's ρ = 0.63, p < 0.001).

Conclusions

In children immediately following kidney transplantation, clinically significant disagreement was found between invasive and noninvasive BP measurements. Invasive BP values were significantly higher than those obtained by Doppler. Better agreement was found between NIBP and Doppler. These issues should be considered when interpreting BP measurements in this sensitive patient population.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

中文翻译：

儿童肾移植后的血压监测：使用多普勒作为基准技术的侵入性和非侵入性测量的比较

背景

小儿肾移植后的血压 (BP) 监测对于优化移植物灌注至关重要。有创血压和无创血压 (NIBP) 测量之间的差异有时相当大。我们的目的是评估肾移植后儿科患者有创血压和 NIBP 之间的一致性，并与使用手动血压计作为参考技术的收缩多普勒测量结果进行比较。

方法

2019 年 5 月至 2021 年 6 月期间，一项前瞻性、观察性队列研究对象为 18 岁或以下的儿童，这些儿童在肾移植后立即被送往大学附属三级医疗中心的儿科重症监护病房。

结果

对 18 名患者的有创血压、无创血压和多普勒血压的 82 对同步测量值进行了比较。患者明显高血压，平均收缩压 NIBP 高于第 95 个百分位数 (96 ± 6%)。有创收缩压测量值显着高于 NIBP（149 ± 20 对 136 ± 15 mmHg，p < 0.001）。在 23% (95% CI 15–34%) 中发现了实质性差异 (≥ 20 mmHg)。收缩压和多普勒血压之间也存在类似的差异（分别为 150 ± 23 和 137 ± 17 mmHg，p < 0.001）。相比之下，收缩 NIBP 与多普勒 BP 非常一致（分别为 135 ± 17 和 138 ± 18，p = 0.27）。在较高的收缩压侵入性 BP 与收缩压多普勒 BP 的差异之间发现了中度至强相关性（Spearman 的 ρ = 0.63，p < 0.001）。