The following is a summary of the “Kidney transplantation outcomes of patients with chronic hypotension in dialysis,” published in the March 2024 issue of Nephrology by Auñón et al.
Chronic hypotension is a persistent concern affecting 5-10% of dialysis patients, yet its impact on kidney transplant outcomes remains poorly understood. While reversible post-transplantation, scant data exist regarding its influence on transplant success. Here, the investigators present an analysis of kidney transplant outcomes in patients with chronic hypotension undergoing transplantation at the center.
Conducting a retrospective observational study, researchers identified 76 patients with chronic hypotension (systolic blood pressure ≤ 100 mmHg at transplantation). A control group of 76 patients with non-hypotensive, matched for organ source and age, was established for comparison. The study group analyzed the evolution of both groups to assess transplant outcomes.
Patients with chronic hypotension exhibited higher rates of primary non-function (18.2% vs. 6.1%, p= 0.03), primarily due to venous thrombosis of the allograft (15.2% vs. 3%, p= 0.015). Additionally, they demonstrated poorer renal function at the follow-up end (eGFR of 35 mL/min/1.73m2 vs. 48 mL/min/1.73m2, p= 0.001). However, no statistical difference in graft survival was observed after censoring for primary non-function. Following multivariable adjustment, chronic hypotension emerged as an independent predictor of kidney graft failure (adjusted HR: 2.85; 95% CI: 1.24-6.57; p= 0.014). Notably, using vasoactive drugs and anticoagulation in hypotensive patients correlated with a lower incidence of venous graft thrombosis (7.1% vs. 17.3%, p= 0.68). Furthermore, receiving a functioning graft led to blood pressure normalization in patients with chronic hypotension.
Chronic hypotension in dialysis significantly impacts short-term kidney transplant outcomes but exhibits a diminished effect on long-term results. Encouragingly, the condition is reversible following successful transplantation. Identifying and addressing this subgroup of patients is paramount to optimizing transplant success rates.
Source: sciencedirect.com/science/article/pii/S2468024924015821