G. Fernandez-fresnedo et al., Hypertension and long-term renal allograft survival: effect of early glomerular filtration rate, NEPH DIAL T, 16, 2001, pp. 105-109
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.