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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

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Abstract

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.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Schneider Children’s Medical Center of Israel, 4920235, Petach Tikva, Israel

    Eytan Kaplan, Gili Kadmon, Elhanan Nahum & Avichai Weissbach

  2. Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel

    Eytan Kaplan, Gili Kadmon, Elhanan Nahum, Hadas Alfandary, Orly Haskin & Avichai Weissbach

  3. Institute of Nephrology, Schneider Children’s Medical Center of Israel, 4920235, Petach Tikva, Israel

    Hadas Alfandary & Orly Haskin

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  1. Eytan Kaplan
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  2. Gili Kadmon
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Correspondence to Eytan Kaplan.

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No funding was received for conducting this study. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript.

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Kaplan, E., Kadmon, G., Nahum, E. et al. Blood pressure monitoring following kidney transplantation in children: a comparison of invasive and noninvasive measurements using Doppler as a benchmark technique. Pediatr Nephrol 38, 1291–1298 (2023). https://doi.org/10.1007/s00467-022-05691-2

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  • DOI: https://doi.org/10.1007/s00467-022-05691-2

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