Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/30294
Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Hypervolemia and Blood Pressure in Prevalent Kidney Transplant Recipients
Author(s): Chan, Winnie
Bosch, Jos A
Jones, David
McTernan, Philip G
Inston, Nicholas
Moore, Sue
Kaur, Okdeep
Phillips, Anna C
Borrows, Richard
Contact Email: a.c.whittaker@stir.ac.uk
Keywords: Hypervolemia
Sodium
Blood pressure
NT-proBNP
Kidney transplantation
Issue Date: 15-Aug-2014
Citation: Chan W, Bosch JA, Jones D, McTernan PG, Inston N, Moore S, Kaur O, Phillips AC & Borrows R (2014) Hypervolemia and Blood Pressure in Prevalent Kidney Transplant Recipients. Transplantation, 98 (3), pp. 320-327. https://doi.org/10.1097/tp.0000000000000066
Abstract: Background The prevalence and consequences of hypervolemia in kidney transplant recipients (KTRs) have not been investigated. Specifically, its impact on blood pressure (BP) and relationship with N-terminal fragment of prohormone B-type natriuretic peptide (NT-proBNP) are unknown. The objectives of this study were to establish the prevalence of hypervolemia among clinically stable KTRs, investigate the predictors of posttransplant hypervolemia, assess its impact on blood pressure, and determine its relationship with NT-proBNP. Methods This single-center cross-sectional study enrolled 123 clinically stable KTRs. Extracellular volume status was determined by multifrequency bioimpedance analysis. Mild and severe hypervolemia were defined as percentage volume expansion of greater than 7% and greater than 15%, respectively. Systolic BP (SBP) and diastolic BP (DBP) were measured, with mean arterial pressure (MAP) calculated. Serum NT-proBNP was quantified using a noncompetitive immunoluminometric assay. Potential demographic, nutritional, and clinical predictors of extracellular volume status, BP, and NT-proBNP levels were assessed. Results Hypervolemia was present in 30% of KTRs, with 5% classified as severe hypervolemia. Significant predictors of volume expansion were increased sodium intake, advancing age, and reduced fat mass (P < 0.01 for all associations). Hypervolemia was the only independent predictor of elevated MAP, SBP, and DBP (P < 0.001 for all associations). Raised NT-proBNP levels were independently associated with both hypervolemia (P=0.01) and allograft dysfunction (P=0.03). Conclusions Hypervolemia is unexpectedly common among clinically stable KTRs. It is closely associated with elevated BP. The relationship with increased sodium intake signals potential therapeutic focus. Further study is warranted to prospectively investigate objective measures of extracellular volume status among KTRs.
DOI Link: 10.1097/tp.0000000000000066
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