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. 2023 Apr;38(4):1319-1327.
doi: 10.1007/s00467-022-05611-4. Epub 2022 Sep 12.

Arterial stiffness and blood pressure increase in pediatric kidney transplant recipients

Rizky Indrameikha Sugianto #  1 , Karen Ostendorf #  1 , Elena Bauer  1 , Jeannine von der Born  1 , Jun Oh  2 , Markus J Kemper  3 , Rainer Buescher  4 , Bernhard M W Schmidt  5 , Nima Memaran #  1 , Anette Melk #  6   7
Affiliations

Arterial stiffness and blood pressure increase in pediatric kidney transplant recipients

Rizky Indrameikha Sugianto et al. Pediatr Nephrol. 2023 Apr.

Abstract

Background: Pulse wave velocity (PWV) is a measure of arterial stiffness. We investigated PWV and blood pressure (BP) to determine to what extent BP changes contribute to arterial stiffness, and secondly, to identify influencing factors on BP in children after kidney transplantation.

Methods: Seventy children ≥ 2.5 years post-transplantation with at least two PWV measurements were included. Changes of systolic (Δ SBP) and diastolic BP (Δ DBP) were classified into "stable/decreasing," "1-10 mmHg increase," and " > 10 mmHg increase." Linear mixed modeling for PWV z-score (PWVz) adjusted either for Δ SBP or Δ DBP was performed. An extended dataset with monthly entries of BP, immunosuppression, and creatinine was obtained in 35 participants over a median of 74 months to perform linear mixed modeling for SBP and DBP.

Results: PWVz increased with a rate of 0.11/year (95% CI 0.054 to 0.16). Compared to participants with stable BP, those with 1-10-mmHg SBP and DBP increase showed a higher PWVz of 0.59 (95% CI 0.046 to 1.13) and 0.86 (95% CI 0.43 to 1.30), respectively. A > 10-mmHg BP increase was associated with an even higher PWVz (SBP β = 0.78, 95% CI 0.22 to 1.34; DBP β = 1.37, 95% CI 0.80 to 1.94). Female sex and participants with lower eGFR showed higher PWVz. In the extended analysis, DBP was positively associated with cyclosporin A and everolimus trough levels.

Conclusions: A higher increase of PWV is seen in patients with greater BP increase, with higher cyclosporin A and everolimus trough levels associated with higher BP. This emphasizes the role of BP as a modifiable risk factor for the improvement of cardiovascular outcome after transplantation. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Arterial hypertension; Arteriosclerosis; Cardiovascular disease; Chronic kidney disease; Pulse wave velocity; Transplantation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

None
A higher resolution version of the Graphical abstract is available as Supplementary information
Fig. 1
Fig. 1
The proportion of hypertension (a), isolated systolic hypertension (b), and isolated diastolic hypertension (c) at baseline visit and 2-year follow-up. Abbreviation: FU, follow-up
Fig. 2
Fig. 2
The longitudinal course of PWV z-score as visualized by regression spline (upper panel) and the mixed model for PWV z-score adjusted for time since transplantation (lower panel). Abbreviations: β, regression coefficient; p, p-value; PWV, pulse wave velocity
Fig. 3
Fig. 3
Illustration for the slopes of PWV z-score according to the defined categories of BP increases (stable/decreasing, 1–10 mmHg, or > 10 mmHg) in systolic or diastolic BP. The slopes are calculated according to the mixed models presented in Tables 2 and 3. Gray lines show the slopes for stable/decreasing systolic and diastolic BP. Black dotted lines show the slopes for systolic and diastolic BP increase of 1–10 mmHg. Black solid lines show the slopes for systolic and diastolic BP increase of > 10 mmHg. Abbreviations: DBP, diastolic blood pressure; PWV, pulse wave velocity; SBP, systolic blood pressure
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