Arterial hypertension in renal transplantation: Clinical implications, pathogenesis and current management strategies

Duni Anila, Paraskevi Pavlakou, Vasileios Koutlas, Irini Tzalavra, Charalambos Pappas, Michalis Mitsis, Evangelia Dounousi

Abstract


Renal transplantation is the treatment of choice in end-stage kidney disease patients. Cardiovascular disease is the main cause of death in dialysis patients. The cardiovascular risk sharply declines after successful renal transplantation, but still death with a functioning graft due to cardiovascular disease is the leading cause of death in renal transplant recipients. Conventional cardiovascular risk factors such as hypertension, diabetes and hyperlipidemia which are common in transplant recipients and are associated with adverse outcomes, are accentuated by the effects of immunosuppressive drugs. More specific, arterial hypertension is a major problem in renal transplantation due to its high prevalence as well as due to its associations with cardiovascular disease and chronic allograph nephropathy. Some of the parameters implicated in the pathogenesis of post-transplant hypertension are donor and recipient factors, acute and chronic allograft injury, and immunosuppressive drugs. A significant and potentially remediable cause of resistant hypertension in renal transplant recipients is renal artery stenosis. Treatment of arterial hypertension in renal transplant patients is challenging due to the lack of established blood pressure goals, the association with multiple comorbidities and the complex immunosuppressive treatment. The aim of this review is to describe the clinical implications of increased blood pressure in renal transplant recipients, the specific settings underlying the pathogenesis of arterial hypertension in this patient population and current management strategies.


Keywords


Arterial Hypertension, renal Transplantation, immunosuppression, cardiovascular disease

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References


Jardine AG, Gaston RS, Fellstrom BC, et al. Prevention of cardiovascular disease in adult recipients of kidney transplants. Lancet 2011; 378: 1419-27

Anastasopoulos NA, Dounousi E, Papachristou E, et al. Cardiovascular disease: Risk factors and applicability of a risk model in a Greek cohort of renal transplant recipients. World J Transplant. 2017; 7: 49-56

Muntner P, Anderson A, Charleston J, et al. Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2010; 55: 441–51

Weir MR, Burgess ED, Cooper JE, et al. Assessment and management of hypertension in transplant patients. J Am Soc Nephrol 2015; 26: 1248–1260

Campistol JM, Romero R, Paul J, et al. Epidemiology of arterial hypertension in renal transplant patients: Changes over the last decade. Nephrol Dial Transplant 2004; 19[Supply 3]: iii62–iii66

Paoletti E, Gherzi M, Amidone M, et al. Association of arterial hypertension with renal target organ damage in kidney transplant recipients: the predictive role of ambulatory blood pressure monitoring. Transplantation 2009; 87: 1864

Rigatto C, Parfrey P, Foley R, et al. Congestive heart failure in renal transplant recipients: Risk factors, outcomes, and relationship with ischemic heart disease. J Am Soc Nephrol 2002; 13: 1084– 1090

Carpenter MA, John A, Weir MR, et al. BP, cardiovascular disease, and death in the Folic Acid for Vascular Outcome Reduction in Transplantation trial. J Am Soc Nephrol 2014; 25: 1554

Jardine AG, Holdaas H, Fellström B, et al. Fluvastatin prevents cardiac death and myocardial infarction in renal transplant recipients: post-hoc subgroup analyses of the ALERT Study. Am J Transplant 2004; 4: 988

Lentine KL, Schnitzler MA, Abbott KC, et al. De novo congestive heart failure after kidney transplantation: a common condition with poor prognostic implications. Am J Kidney Dis 2005; 46: 720

Mange KC, Cizman B, Joffe M, et al. Arterial hypertension and renal allograftsurvival. JAMA 2000; 283: 633–638

Mange KC, Feldman HI, Joffe MM, et al. Blood pressure and the survival of renal allografts from living donors. J Am Soc Nephrol 2004; 15: 187–193

Kasiske BL, Anjum S, Shah R, et al. Hypertension after kidney transplantation. Am J Kidney Dis 2004; 43: 1071–1081

Cowley AW Jr, Roman RJ. The role of the kidney in hypertension. JAMA 1996; 275: 1581

Guidi E, Menghetti D, Milani S, et al. Hypertension may be transplanted with the kidney in humans: a long-term historical prospective follow-up of recipients grafted with kidneys coming from donors with or without hypertension in their families. J Am Soc Nephrol 1996; 7: 1131

Curtis JJ, Luke RG, Dustan HP, et al. Remission of essential hypertension after renal transplantation. N Engl J Med 1983; 309: 1009

Beecroft JR, Rajan DK, Clark TW, et al. Transplant renal artery stenosis: Outcome after percutaneous intervention. J Vasc Interv Radiol 2004; 15: 1407– 1413

Audard V, Matignon M, Hemery F, et al. Risk factors and long-term outcome of transplant renal artery stenosis in adult recipients after treatment by percutaneous transluminal angioplasty. Am J Transplant 2006; 6: 95

Humar A, Matas AJ. Surgical complications after kidney transplantation. Semin Dial 2005; 18: 505

Giessing M, Fuller TF, Tuellmann M, et al. Steroid an calcineurin inhibitor free immunosuppression in kidney transplantation: State of the art and future developments. World J Urol 2007; 25: 325–332

Roullet JB, Xue H, McCarron DA, Holcomb S, Bennett WM: Vascular mechanisms of cyclosporin-induced hypertension in the rat. J Clin Invest 1994; 93: 2244–2250

Hoorn EJ, Walsh SB, McCormick JA, et al. The calcineurin inhibitor tacrolimus activates the renal sodium chloride cotransporter to cause hypertension. Nat Med 2011; 1304–1309

Krämer BK, Del Castillo D, Margreiter R, et al. European Tacrolimus versus Ciclosporin Microemulsion Renal Transplantation Study Group: Efficacy and safety of tacrolimus compared with ciclosporin A in renal transplantation: Three-year observational results. Nephrol Dial Transplant 2008; 23: 2386–2392

Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021-104

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/ AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension 2018; 71: 1269-1324

Kendirlinan Demirkol O, Oruc M, Ikitimur B, et al. Ambulatory Blood Pressure Monitoring and Echocardiographic Findings in Renal Transplant Recipients. J Clin Hypertens (Greenwich). 2016; 18: 766-771

Mallamaci F, D’Arrigo G, Tripepi R, et al. Office, standardized and 24h ambulatory blood pressure and renal function loss in renal transplant patients. J Hypertens. 2018; 36: 119-125

KDIGO clinical practice guideline for the care of kidney transplant recipients. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. Am J Transplant. 2009 Nov; 9 Suppl 3: S1-155

Mourer JS, de Koning EJ, van Zwet EW, et al. Impact of late calcineurin inhibitor withdrawal on ambulatory blood pressure and carotid intima media thickness in renal transplant recipients. Transplantation 2013; 96: 49

Mangray M, Vella JP. Hypertension after kidney transplant. Am J Kidney Dis 2011; 57: 331

Rossi AP, Vella JP. Hypertension, living kidney donors, and transplantation: where are we today? Adv Chronic Kidney Dis 2015; 22: 154

Cross NB, Webster AC, Masson P, et al. Antihypertensive treatment for kidney transplant recipients. Cochrane Database Syst Rev 2009; CD003598

Ladefoged SD, Pedersen E, Hammer M, et al. Influence of diltiazem on renal function and rejection in renal allograft recipients receiving triple-drug immunosuppression: a randomized, double-blind, placebo-controlled study. Nephrol Dial Transplant 1994; 9: 543

Kovarik JM, Beyer D, Bizot MN, et al. Pharmacokinetic interaction between verapamil and everolimus in healthy subjects. Br J Clin Pharmacol 2005; 60: 434

Hiremath S, Fergusson DA, Fergusson N, et al. Renin-Angiotensin System Blockade and Long-term Clinical Outcomes in Kidney Transplant Recipients: A Meta-analysis of Randomized Controlled Trials. Am J Kidney Dis. 2017; 69: 78-86

Knoll GA, Fergusson D, Chassé M, et al. Ramipril versus placebo in kidney transplant patients with proteinuria: a multicentre, double-blind, randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4: 318-26

Stigant CE, Cohen J, Vivera M, et al. ACE inhibitors and angiotensin II antagonists in renal transplantation: an analysis of safety and efficacy. Am J Kidney Dis 2000; 35: 58

Fricke L, Doehn C, Steinhoff J, et al. Treatment of posttransplant hypertension by laparoscopic bilateral nephrectomy? Transplantation 1998; 65: 1182




DOI: http://dx.doi.org/10.23803/hja.v9i4.195

DOI (PDF): http://dx.doi.org/10.23803/hja.v9i4.195.g169

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