ESPN 50th Annual Meeting

ESPN 2017


 
BLOOD PRESSURE MONITORING AND TREATMENT POST PAEDIATRIC RENAL TRANSPLANTATION: A LONGITUDINAL STUDY OF PAEDIATRIC PATIENTS IN SCOTLAND
SARAH HENDERSON 1 John McColl 2 Ian Ramage 3

1- ROYAL HOSPITAL FOR SICK CHILDREN, EDINBURGH, UK
2- University of Glasgow, School of Mathematics and Statistics, Glasgow, United Kingdom
3- Royal Hospital for Children, Renal Unit, Glasgow, United Kingdom
 
Introduction:

Hypertension is a recognised complication of renal transplantation and is common in patients with end stage renal failure (ESRF). Renal transplantation is recognised to produce significant survival benefits in patients with ESRF. Hypertension in the ESRF population is a known risk factor for the development of cardiovascular disease and is associated with poorer graft function.

Material and methods:

A retrospective review was undertaken of all paediatric patients receiving a renal transplant in Scotland from January 2001 to July 2014. During this period 119 patients were identified, aged 2.4 years to 20.3 years at time of transplantation. Data gathered included demographics, diagnoses, blood results, blood pressure and BMI (body mass index) over time.

Results:

23 patients had pre-emptive transplants, 34 were on haemodialysis and 62 peritoneal dialysis prior to transplantation. On long term follow up 4 patients were deceased, 2 had moved out of area, 108 were in transplant clinic follow up and 5 were on haemodialysis. Our results demonstrate that post-transplant 15-39% of our patients had systolic blood pressures (SBP) of over 95th Centile during the 5 year follow up period, with a peak at 30 days post transplantation. During this period there were 17.6% to 31.0% of patients recorded to be receiving antihypertensive medication. The estimated glomerular filtration rate (eGFR) at the different time points was recorded and whether antihypertensives were prescribed at these time points. Results showed that patients receiving antihypertensives tended to have higher eGFR, however this was not statistically significant.

Conclusions:

Our data demonstrates a peak of SPB 30 days post transplant which is in keeping with previous data. However overall our study population demonstrated a much lower level of hypertension than previous studies, which suggest 60-90% of patients are hypertensive after renal transplant. Interestingly we found that patients on antihypertensive treatment tended to have longer time with eGFR greater than 30ml/min/1.73m2, than those not receiving antihypertensives. This result was unexpected as we would expect those with hypertension to have poorer renal function. This positive association with antihypertensives and increased GFR may be a surrogate marker for compliance. An alternative explanation may be that we need to be more aggressive with hypertension management post transplantation aiming for a lower SBP.