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Vol 21, No 4 (2017)
Original paper
Published online: 2017-08-30
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Evaluation of the relationship between circadian blood pressure profile and natriuresis in patients with chronic kidney disease and renal transplant recipients

Małgorzata Jadwiga Wajdlich1, Filip Bielec2, Bogumiła Górczyńska2, Jakub Krawczyk2, Sylwia Lewandowska2, Aneta Małyska2, Ewa Szczepanik2, Kamila Wysocka2, Michał Nowicki3
DOI: 10.5603/AH.a2017.0017
·
Arterial Hypertension 2017;21(4):171-179.
Affiliations
  1. Klinika Nefrologii, Hipertensjologii i Transplantologii Nerek Centralny Szpital Kliniczny, ul. Pomorska 251, 92-213 Łódź, Poland
  2. Studenckie Koło Naukowe przy Klinice Nefrologii, Hipertensjologii i Transplantologii Nerek, ul. Pomorska 251, 92-213 Łódź, Poland
  3. Klinika Nefrologii, Hipertensjologii i Transplantologii Nerek, ul. Pomorska 251, 92-213 Łódź, Poland

open access

Vol 21, No 4 (2017)
ORIGINAL PAPERS
Published online: 2017-08-30

Abstract

Introduction. The disturbed circadian rhythm of blood pressure (BP) is more prevalent in patients with chronic kidney disease (CKD). Diminished renal capacity to excrete sodium may result in nocturnal BP elevation in order to enhance pressure natriuresis to compensate for impaired daytime natriuresis. We hypothesized that kidney transplantation (KTx) that restores glomerular filtration should normalize circadian BP profile. The aim of the study was to assess and compare natriuresis and circadian BP profiles of patients at different stages of CKD and KTx recipients. Material and methods. Blood pressure was monitored noninvasively for 24 hours and urinary samples were collected during the daytime and night-time to measure natriuresis among 55 patients with stable graft or kidney function: 41 with CKD and 14 patients after KTx. Results. Mean awake systolic blood pressure (SBP) was lower in KTx recipients than in CKD at all stages. Night-time mean BP was lowest in CKD patients with eGFR > 45 ml/min (126/68 mmHg vs. KTx 130/75 mmHg; p = 0.005). The prevalence of dipper status was also highest in CKD patients with eGFR > 45 ml/min. 50% vs. 8.3% (CKD 3b), 0% (CKD 4–5) and 7.1% (KTx) (p < 0.01), whereas reverse status was the rarest. Nocturnal blood pressure fall correlated inversely with night to day natriuresis ratios in both groups (CKD r = –0.91 p < 0.01; KTx r = –0.63 p = 0.016). The dipping profile was present only in KTx patients with eGFR > 60 ml/min, whereas reverse dipping profile only in those with eGFR < 60 ml/min. More than half CKD patients were taking at least 4 antihypertensive medications. In contrast, 64% of KTx recipients were receiving no more than 3 antihypertensive drugs to control BP. Conclusions. Kidney transplantation improves blood pressure control and reduces a number of antihypertensive drugs used. Normal circadian rhythm could be restored only in the transplant patients with well-functioning renal graft.

Abstract

Introduction. The disturbed circadian rhythm of blood pressure (BP) is more prevalent in patients with chronic kidney disease (CKD). Diminished renal capacity to excrete sodium may result in nocturnal BP elevation in order to enhance pressure natriuresis to compensate for impaired daytime natriuresis. We hypothesized that kidney transplantation (KTx) that restores glomerular filtration should normalize circadian BP profile. The aim of the study was to assess and compare natriuresis and circadian BP profiles of patients at different stages of CKD and KTx recipients. Material and methods. Blood pressure was monitored noninvasively for 24 hours and urinary samples were collected during the daytime and night-time to measure natriuresis among 55 patients with stable graft or kidney function: 41 with CKD and 14 patients after KTx. Results. Mean awake systolic blood pressure (SBP) was lower in KTx recipients than in CKD at all stages. Night-time mean BP was lowest in CKD patients with eGFR > 45 ml/min (126/68 mmHg vs. KTx 130/75 mmHg; p = 0.005). The prevalence of dipper status was also highest in CKD patients with eGFR > 45 ml/min. 50% vs. 8.3% (CKD 3b), 0% (CKD 4–5) and 7.1% (KTx) (p < 0.01), whereas reverse status was the rarest. Nocturnal blood pressure fall correlated inversely with night to day natriuresis ratios in both groups (CKD r = –0.91 p < 0.01; KTx r = –0.63 p = 0.016). The dipping profile was present only in KTx patients with eGFR > 60 ml/min, whereas reverse dipping profile only in those with eGFR < 60 ml/min. More than half CKD patients were taking at least 4 antihypertensive medications. In contrast, 64% of KTx recipients were receiving no more than 3 antihypertensive drugs to control BP. Conclusions. Kidney transplantation improves blood pressure control and reduces a number of antihypertensive drugs used. Normal circadian rhythm could be restored only in the transplant patients with well-functioning renal graft.

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Keywords

circadian rhythm of blood pressure, chronic kidney disease, kidney transplantation, natriuresis

About this article
Title

Evaluation of the relationship between circadian blood pressure profile and natriuresis in patients with chronic kidney disease and renal transplant recipients

Journal

Arterial Hypertension

Issue

Vol 21, No 4 (2017)

Article type

Original paper

Pages

171-179

Published online

2017-08-30

Page views

889

Article views/downloads

827

DOI

10.5603/AH.a2017.0017

Bibliographic record

Arterial Hypertension 2017;21(4):171-179.

Keywords

circadian rhythm of blood pressure
chronic kidney disease
kidney transplantation
natriuresis

Authors

Małgorzata Jadwiga Wajdlich
Filip Bielec
Bogumiła Górczyńska
Jakub Krawczyk
Sylwia Lewandowska
Aneta Małyska
Ewa Szczepanik
Kamila Wysocka
Michał Nowicki

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