Arterial stiffness and blood pressure increase in pediatric kidney transplant recipients,Pediatric Nephrology

当前位置： X-MOL 学术 › Pediatr. Nephrol. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Arterial stiffness and blood pressure increase in pediatric kidney transplant recipients
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2022-09-12 , DOI: 10.1007/s00467-022-05611-4
Rizky Indrameikha Sugianto ₁ , Karen Ostendorf ₁ , Elena Bauer ₁ , Jeannine von der Born ₁ , Jun Oh ₂ , Markus J Kemper ₃ , Rainer Buescher ₄ , Bernhard M W Schmidt ₅ , Nima Memaran ₁ , Anette Melk _{1,

6}

Affiliation

Background

Pulse wave velocity (PWV) is a measure of arterial stiffness. We investigated PWV and blood pressure (BP) to determine to what extent BP changes contribute to arterial stiffness, and secondly, to identify influencing factors on BP in children after kidney transplantation.

Methods

Seventy children ≥ 2.5 years post-transplantation with at least two PWV measurements were included. Changes of systolic (Δ SBP) and diastolic BP (Δ DBP) were classified into “stable/decreasing,” “1–10 mmHg increase,” and “ > 10 mmHg increase.” Linear mixed modeling for PWV z-score (PWVz) adjusted either for Δ SBP or Δ DBP was performed. An extended dataset with monthly entries of BP, immunosuppression, and creatinine was obtained in 35 participants over a median of 74 months to perform linear mixed modeling for SBP and DBP.

Results

PWVz increased with a rate of 0.11/year (95% CI 0.054 to 0.16). Compared to participants with stable BP, those with 1–10-mmHg SBP and DBP increase showed a higher PWVz of 0.59 (95% CI 0.046 to 1.13) and 0.86 (95% CI 0.43 to 1.30), respectively. A > 10-mmHg BP increase was associated with an even higher PWVz (SBP β = 0.78, 95% CI 0.22 to 1.34; DBP β = 1.37, 95% CI 0.80 to 1.94). Female sex and participants with lower eGFR showed higher PWVz.

In the extended analysis, DBP was positively associated with cyclosporin A and everolimus trough levels.

Conclusions

A higher increase of PWV is seen in patients with greater BP increase, with higher cyclosporin A and everolimus trough levels associated with higher BP. This emphasizes the role of BP as a modifiable risk factor for the improvement of cardiovascular outcome after transplantation.

Graphical abstract

中文翻译：

小儿肾移植受者的动脉硬化和血压升高

背景

脉搏波速度 (PWV) 是动脉硬度的量度。我们调查了 PWV 和血压 (BP)，以确定血压变化在多大程度上导致动脉硬化，其次，确定肾移植后儿童血压的影响因素。

方法

包括 70 名至少进行过两次 PWV 测量的移植后 ≥ 2.5 岁的儿童。收缩压 (Δ SBP) 和舒张压 (Δ DBP) 的变化分为“稳定/下降”、“1-10 mmHg 增加”和“> 10 mmHg 增加”。执行针对 Δ SBP 或 Δ DBP 调整的PWV z分数 (PWVz)的线性混合建模。在平均 74 个月的时间里，从 35 名参与者中获得了每月输入血压、免疫抑制和肌酐的扩展数据集，以对 SBP 和 DBP 进行线性混合建模。

结果

PWVz 以每年 0.11 的速度增加（95% CI 0.054 至 0.16）。与血压稳定的参与者相比，收缩压和舒张压增加 1-10 毫米汞柱的参与者显示更高的 PWVz，分别为 0.59（95% CI 0.046 至 1.13）和 0.86（95% CI 0.43 至 1.30）。> 10 mmHg 的血压升高与更高的 PWVz 相关（SBP β = 0.78，95% CI 0.22 至 1.34；DBP β = 1.37，95% CI 0.80 至 1.94）。女性和 eGFR 较低的参与者表现出较高的 PWVz。

在扩展分析中，DBP 与环孢菌素 A 和依维莫司谷水平呈正相关。