Ocena zależności między dobowym profilem ciśnienia tętniczego a natriurezą u pacjentów z przewlekłą chorobą nerek oraz po przeszczepieniu nerki

Introduction. The disturbed circadian rhythm of blood pressure (BP) is more prevalent in patients with chronic kidney disease (CKD). Diminished renal capacity to excrete sodium may result in nocturnal BP elevation in order to enhance pressure natriuresis to compensate for impaired daytime natriuresis. We hypothesized that kidney transplantation (KTx) that restores glomerular filtration should normalize circadian BP profile. The aim of the study was to assess and compare natriuresis and circadian BP profiles of patients at different stages of CKD and KTx recipients.

Material and methods. Blood pressure was monitored noninvasively for 24 hours and urinary samples were collected during the daytime and night-time to measure natriuresis among 55 patients with stable graft or kidney function: 41 with CKD and 14 patients after KTx.

Results. Mean awake systolic blood pressure (SBP) was lower in KTx recipients than in CKD at all stages. Night-time mean BP was lowest in CKD patients with eGFR > 45 ml/min (126/68 mm Hg vs. KTx 130/75 mm Hg; p = 0.005). The prevalence of dipper status was also highest in CKD patients with eGFR > 45 ml/min. 50% vs. 8.3% (CKD 3b), 0% (CKD 4–5) and 7.1% (KTx) (p < 0.01), whereas reverse status was the rarest. Nocturnal blood pressure fall correlated inversely with night to day natriuresis ratios in both groups (CKD r = –0.91 p < 0.01; KTx r = –0.63 p = 0.016). The dipping profile was present only in KTx patients with eGFR > 60 ml/min, whereas reverse dipping profile only in those with eGFR < 60 ml/min. More than half CKD patients were taking at least 4 antihypertensive medications. In contrast, 64% of KTx recipients were receiving no more than 3 antihypertensive drugs to control BP.

Conclusions. Kidney transplantation improves blood pressure control and reduces a number of antihypertensive drugs used. Normal circadian rhythm could be restored only in the transplant patients with well-functioning renal graft

Arterial Hypertens. 2017, vol. 21, no. 4, pages: 171–179 DOI: 10.5603/AH.a2017.0017