Significance of ambulatory blood pressure monitoring in assessment of potential living kidney donors

الملخص EN

The most recent British Transplant Society (BTS) guidelines recommend that office blood pressure (BP) monitoring in living donors is sufficient for the assessment of hypertension (HTN) and those with BP >140/90 should be further assessed using ambulatory BP monitoring (ABPM).

ABPM can detect diurnal and nocturnal variation in BP, thus it can identify masked HTN.

The aim of the current study is to assess reliability of ABPM vesus office BP monitoring for assessment in living kidney donors.

Office and ABPM of all potential kidney donors at a single center from April 2009 to March 2017 were retrospectively reviewed and compared.

Age, sex, body mass index, kidney function, and echocardiography results were collected and analyzed.

Two hundred and sixteen kidney donors were stratified based on their BP readings into four groups; group 1 (masked HTN: normotensive in office and hypertensive in ABPM), group 2 (sustained normotension: normotensive in office and in ABPM), group 3 (sustained HTN: hypertensive in office and in ABPM), group 4 (white-coat HTN: hypertensive in office and normotensive in ABPM).

Thirteen percent of patients were diagnosed with masked HTN.

Office systolic BP monitoring was significantly higher in patients older than 50 years old compared to other younger populations.

However, this significant difference in systolic BP was diminished when assessment with ABPM was performed.

In conclusion, ABPM is a reliable modality for the identification of masked HTN and white coat HTN.

Masked HTN is correlated with increased risk of end organ damage and risk of death in potential kidney donors.

Transplant physicians cannot rely solely on office BP monitoring in the assessment of potential living kidney donors.

ABPM should be integral part of routine assessment of potential living kidney donors.