Hypertension and long-term renal allograft survival: effect of early glomerular filtration rate

Background. For many years, hypertension has been related to long-term surv ival of patients and kidney grafts, although the nature of this relationshi p has not been completely defined. The aim of this study was to analyse the influence of early glomerular filtration rate on post-transplant hypertens ion and on graft survival. Methods. A total of 432 kidney transplanted patients on cyclosporin therapy , with a functioning graft for at least 1 year, were studied. They were div ided into two groups depending on their early creatinine clearance: group A [<60 ml/min (n=270)] and group B [ > 60 ml/min (n = 162)]. Results. There were no differences in sex, aetiology of renal failure, numb er of retransplants, PRA, HLA mismatches and pre-transplant blood pressure. One year after transplantation, blood pressure was higher in group A (syst olic BP 148/diastolic BP 86/mean BP 117) than in group B (systolic BP 140/d iastolic BP 82/mean BP 111) (P<0.003). We observed a negative correlation b etween early creatinine clearance and 1-year blood pressure (P<0.01). Five and 10 year graft survival was 60 and 37% in group A and 87 and 69% in grou p B, respectively (P<0.000). A multivariate Cox analysis showed that 1-year blood pressure (P < 0.0029, RR = 1.76) and early creatinine clearance (P<0 .000, RR=3.27) had a significant influence on graft survival. Conclusions. The 1-year post-transplant blood pressure is a non-immunologic al risk factor in long-term graft survival. Patients with a lower initial g lomerular filtration rate are more susceptible to the development of second ary hypertension and worse graft survival.