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. 2024 Mar 18;9(6):1742-1751.
doi: 10.1016/j.ekir.2024.03.012. eCollection 2024 Jun.

Kidney Transplantation Outcomes of Patients With Chronic Hypotension in Dialysis

Pilar Auñón  1 , Teresa Cavero  1 , Ana García  2 , Jorge González  3 , Amado Andrés  1   4
Affiliations

Kidney Transplantation Outcomes of Patients With Chronic Hypotension in Dialysis

Pilar Auñón et al. Kidney Int Rep. .

Abstract

Introduction: Persistent chronic hypotension affects 5-10% of dialysis patients. It seems to be reversible after receiving a functioning graft, but data regarding its influence on transplant outcomes are scarce. We analyze the evolution of patients with chronic hypotension in dialysis who undergo kidney transplantation at our center.

Methods: A retrospective observational study was conducted. Sixty-six patients with chronic hypotension (defined as systolic blood pressure ≤ 100 mm Hg at the time of transplantation) were identified. A control group of 66 non-hypotensive patients was assigned. The evolution of both groups was compared.

Results: Hypotensive patients had higher rates of primary non-function (18.2% vs. 6.1%; P = 0.03) mainly due to venous thrombosis of the allograft, worse renal function at the end of follow-up (eGFR of 35 mL/min/1.73 m2 vs 48 mL/min/1.73 m2, P = 0.001) but there was no statistical difference in graft survival after censoring for primary non-function. After multivariable adjustment, chronic hypotension remained an independent predictor factor for graft failure (adjusted HR of 2.85; 95% CI: 1.24-6.57; P = 0.014). Use of vasoactive drugs and anticoagulation in hypotensive patients was associated with 7.1% of venous graft thrombosis compared to 17.3% in those with no intervention (P = 0.68). Receiving a functioning graft implied blood pressure normalization in patients with chronic hypotension.

Conclusion: Chronic hypotension in dialysis has a negative impact on short-term kidney transplant outcomes but a lower impact on long-term results. It is reversible after receiving a functioning graft. Identifying this subgroup of patients seems crucial to implement measures aimed at improving transplant results.

Keywords: chronic hypotension; graft survival; kidney transplantation; outcomes; primary nonfunction; venous allograft thrombosis.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Evolution of serum creatinine in both groups.
Figure 2
Figure 2
Renal graft survival in both groups; (a) renal graft survival, (b) composite of graft failure and death, and (c) censored by primary nonfunction.
Figure 3
Figure 3
Use of vasoactive drugs and anticoagulation in the immediate posttransplant period.
Figure 4
Figure 4
Evolution of blood pressure after kidney transplantation; (a) in the hypotensive group, and (b) in the control group.
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