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. 2023 Jul 14:10:1185001.
doi: 10.3389/fcvm.2023.1185001. eCollection 2023.

Uncontrolled hypertension is associated with increased risk of graft failure in kidney transplant recipients: a nationwide population-based study

Chang Seong Kim  1   2 , Tae Ryom Oh  1   2 , Sang Heon Suh  1   2 , Hong Sang Choi  1   2 , Eun Hui Bae  1   2 , Seong Kwon Ma  1   2 , Jin Hyung Jung  3 , Bongseong Kim  4 , Kyung-Do Han #  4 , Soo Wan Kim #  1   2
Affiliations

Uncontrolled hypertension is associated with increased risk of graft failure in kidney transplant recipients: a nationwide population-based study

Chang Seong Kim et al. Front Cardiovasc Med. .

Abstract

Backgroud: Hypertension is highly prevalent in patients with kidney transplantation caused by transplantation-related immunologic or non-immunologic risk factors. However, whether a strict definition of hypertension (≥130/80 mmHg) and subdivided blood pressure (BP) groups are associated with an increased risk of graft failure after kidney transplantation using a nationwide large cohort study are still unknown.

Methods: Using Korean National Health Insurance Service data, we included 14,249 patients who underwent kidney transplantation from 2002 to 2016. Patients were categorized into five BP groups according to the 2021 Kidney Disease: Improving Global Outcomes practice guidelines for BP management: normal BP (<120/80 mmHg), elevated BP (120-129/ < 80 mmHg), incident hypertension (≥130/80 mmHg), and controlled or uncontrolled hypertension with anti-hypertensive medications.

Results: The primary outcome was graft failure, which occurred in 1934 (13.6%) participants during the 6-year follow-up. After adjusting for covariates, hypertension was associated with a higher risk of graft failure [Adjusted hazard ratio (AHR), 1.70; 95% confidence interval (CI), 1.48-1.96)] than no-hypertension. The AHR for graft failure was the highest in patients with uncontrolled hypertension (AHR, 2.13; 95% CI, 1.80-2.52). The risk of graft failure had a linear relationship with systolic and diastolic BP, and pulse pressure.

Conclusions: In this nationwide population-based study, hypertension ≥130/80 mmHg based on the 2021 KDIGO BP guidelines in kidney transplantion recipients, and elevated systolic and diastolic BP, and pulse pressure were associated with the risk of developing graft failure in kidney transplant recipients.

Keywords: graft failure; hypertension; kidney; risk; transplantation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of participant enrollment.
Figure 2
Figure 2
Kaplan–Meier curve for the incidence probability of death-censored graft failure with or without hypertension, and five hypertension groups. BP, blood pressure; HTN, hypertension.
Figure 3
Figure 3
Smoothed hazard ratios curves of the associations of SBP, DBP, and PP with death-censored graft failure in kidney transplant recipients in adjusted Cox-model 3. CI, confidence interval.
Figure 4
Figure 4
Subgroup analysis of the association between hypertension and death-censored graft failure in adjusted Cox-model 3. Points and bars represent hazard ratio estimates and their associated 95% CIs, respectively. CI, confidential interval; DM, diabetes mellitus.
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