NIV Congres
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Blood Pressure and Sodium Excretion in Kidney Transplant Recipients on Different Immunosuppressive Regimens
Dobrowolski, L.C., Bemelman, F. J., Berge, I.J.M. ten, Krediet, C.T. P.
Categorie(ën):
Background Hypertension is a well-known side effect of the immunosuppressive calcineurinine inhibitors (CNI) cyclosporine and tacrolimus. Whereas from cyclosporine it has been well established that it causes a sodium-loading sensitive form of hypertension, for tacrolimus this is not the case.
Tacrolimus is assumed to exert a similar effect on salt sensitivity as cyclosporine. Therefore we hypothesized that among kidney transplant recipients using tacrolimus there would be a higher correlation between daily sodium excretion and pulse pressure than among patients on other (i.e. non tacrolimus or cyclosporine) immunosuppressive regimens.
Methods We retrieved data from our clinical database on the 539 KTRs currently followed in our center. We stratified the patients in tacrolimus (n= 285), cyclosporine (n= 114) or non-CNI users (n= 139). For our primary analysis we included pulse pressure (i.e. an integrated measure for both diastolic and systolic pressure, which may correlate better with volume status than mean arterial pressure) and 24-hour ambulatory urine sodium excretion in a univariate linear regression analysis in each of the three groups. In secondary analyses we controlled for serum creatinine, age and time after transplantation.
Results Systolic blood pressure was higher in the tacrolimus (135mmHg) and cyclosporine (136mmHg) group than in the non-CNI group (130 mmHg, p = 0.004); pulse pressure was similar (54, 51, 50 mmHg, p = 0.07). Sodium excretion was higher in the tacrolimus (152 mmol) and cyclosporine (150 mmol) group than in the non-CNI group (137 mmol, p =0.038). The correlation between sodium excretion and pulse pressure was only significant in the tacrolimus group (R 0,14; p=0.02). In the multivariate linear regression analysis, sodium excretion (p= 0,031) and age (p <0,001) but not serum creatinin or time after transplantation, resulted in a combined R to predict pulse pressure of 0.539.
Conclusion Among kidney transplant recipients using tacrolimus, daily sodium excretion is correlated to pulse pressure. This suggests hypertension in these patients is salt sensitive and that they will benefit more in terms of blood pressure effect from lowering salt intake than patients on non-CNI regimens.