Intensive blood pressure control preserves kidney allograft function
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Kidney transplant recipients whose blood pressure met “intensive” targets experienced better outcomes 5 years after transplantation than those with higher blood pressure, according to findings presented at the American Transplant Congress.
Outcomes included an increased likelihood of preserved allograft function, as well as superior rates of patient and graft survival.
“The latest [Kidney Disease Improving Global Outcomes] KDIGO guidelines published earlier this year suggest a blood pressure target of less than 130 [mmHg] for systolic and less than 80 [mmHg] for diastolic but do not make any concrete recommendations because of the lacking randomized controlled trial data,” Krishna Agarwal, MBBS, of Beth Israel Deaconess Medical Center in Boston, told the audience during his virtual presentation.
To further research in this area, Agarwal and colleagues conducted a retrospective cohort analysis of 473 patients who received a kidney transplant at Beth Israel Deaconess Medical Center between January 2002 and December 2015. The cohort was categorized into three groups based on systolic blood pressure: less than or equal to 120 mmHg, 121 mmHg to 130 mmHg or greater than 130 mmHg.
For 5 years following transplantation, researchers obtained measurements for participants’ blood pressure, serum creatinine and urine protein-to-creatinine ratio every 3 months.
Agarwal noted the mean GFR at 12 months was 51.5 mL/min/1.73 m2 for the entire cohort, with those in the highest systolic blood pressure group having the lowest GFR (49.5 mL/min/1.73 m2); mean GFR did not change for any of the groups during the 5-year follow-up period.
Results indicated a systolic blood pressure between 121 mmHg and 130 mmHg conferred the best outcomes in terms of both patient and graft survival at 5 years.
Overall, 16% of the cohort experienced a GFR decline of at least 25%; this occurred most frequently in the highest category of systolic blood pressure where 19% experienced the decline compared with 12% in the other groups.
When examining urine protein-to-creatinine ratio, Agarwal and colleagues determined 9% of recipients in the 121 mmHg to 130 mmHg category had more than 1 gram of proteinuria compared with 15% of those with systolic blood pressure of less than 120 mmHg and 19.4% of those with systolic blood pressure greater than 130 mm Hg (overall, 75% had less than half a gram of proteinuria).
“Based on these results, we can conclude that a systolic blood pressure target of 121 [mmHg] to 130 mmHg is associated with improved patient and graft survival, as well as a slower decline in kidney allograft function as compared to SBP under 120 [mmHg] or greater than 130 [mmHg],” Agarwal said. “So far, we have not included any comorbidities or medications in this data but we’re already working on that and hope to be out with that data soon.”