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Pediatric Nephrology

, Volume 34, Issue 2, pp 341–348 | Cite as

Steroid withdrawal improves blood pressure control and nocturnal dipping in pediatric renal transplant recipients: analysis of a prospective, randomized, controlled trial

  • Britta HöckerEmail author
  • Lutz T. Weber
  • Ulrike John
  • Jens Drube
  • Henry Fehrenbach
  • Günter Klaus
  • Martin Pohl
  • Tomáš Seeman
  • Alexander Fichtner
  • Elke Wühl
  • Burkhard Tönshoff
Original Article
Part of the following topical collections:
  1. What’s New in Renal Transplantation

Abstract

Background

Variable effects of steroid minimization strategies on blood pressure in pediatric renal transplant recipients have been reported, but data on the effect of steroid withdrawal on ambulatory blood pressure and circadian blood pressure rhythm have not been published so far.

Methods

In a prospective, randomized, multicenter study on steroid withdrawal in pediatric renal transplant recipients (n = 42) on cyclosporine, mycophenolate mofetil, and methylprednisolone, we performed a substudy in 28 patients, aged 11.2 ± 3.8 years, for whom ambulatory blood pressure monitoring (ABPM) data were available.

Results

In the steroid-withdrawal group, the percentage of patients with arterial hypertension, defined as systolic and/or diastolic blood pressure values recorded by ABPM > 1.64 SDS and/or antihypertensive medication, at month 15 was significantly lower (35.7%, p = 0.002) than in controls (92.9%). The need of antihypertensive medication dropped significantly by 61.2% (p < 0.000 vs. control), while in controls, it even rose by 69.3%. One year after steroid withdrawal, no patient exhibited hypertensive blood pressure values above the 95th percentile, compared to 35.7% at baseline (p = 0.014) and to 14.3% of control (p = 0.142). The beneficial impact of steroid withdrawal was especially pronounced for nocturnal blood pressure, leading to a recovered circadian rhythm in 71.4% of patients vs. 14.3% at baseline (p = 0.002), while the percentage of controls with an abnormal circadian rhythm (35.7%) did not change.

Conclusions

Steroid withdrawal in pediatric renal transplant recipients with well-preserved allograft function is associated with less arterial hypertension recorded by ABPM and recovery of circadian blood pressure rhythm by restoration of nocturnal blood pressure dipping.

Keywords

Pediatric renal transplantation Steroid withdrawal Ambulatory blood pressure Nocturnal blood pressure dipping Randomized controlled trial 

Notes

Acknowledgements

Our special thanks are due to all patients for their readiness to participate in this study.

Authors’ contributions

B.H. participated in recruiting patients for the study, data collection and analysis, and preparation of the manuscript. L.T.W. and B.T. participated in study design, recruiting patients for the study, data collection and analysis, and preparation of the manuscript. U.J., J.D., H.F., G.K., and M.P. participated in recruiting patients for the study and data collection. T.S. participated in statistical analysis of the study data. E.W. participated in the statistical analysis of the study data and manuscript preparation.

Funding

The study was sponsored by a grant from Roche, Grenzach-Wyhlen, Germany. Neither did the company influence the performance and analysis of the study nor its publication.

Compliance with ethical standards

The study was conducted in accordance with the Good Clinical Practice Guidelines and the 1983 Helsinki Declaration and approved by the ethics committee of each contributing center. Written informed consent from patients’ parents or guardians was obtained prior to initiation of any study-related procedure, with assent from patients when appropriate for their age.

Conflict of interest

This was an investigator-initiated trial undertaken by members of the “German Study Group on Renal Transplantation in Children and Adolescents” and members of the “German Society of Pediatric Nephrology (GPN)”. B.H., L.T.W., and B.T. have received travel grants from Roche. B.T. has also received research grants from Roche.

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Copyright information

© IPNA 2018

Authors and Affiliations

  • Britta Höcker
    • 1
    Email author return OK on get
  • Lutz T. Weber
    • 2
  • Ulrike John
    • 3
  • Jens Drube
    • 4
  • Henry Fehrenbach
    • 5
  • Günter Klaus
    • 6
  • Martin Pohl
    • 7
  • Tomáš Seeman
    • 8
  • Alexander Fichtner
    • 1
  • Elke Wühl
    • 1
  • Burkhard Tönshoff
    • 1
  1. 1.Department of Pediatrics IUniversity Children’s HospitalHeidelbergGermany
  2. 2.Pediatric Nephrology, Children’s and Adolescents’ HospitalUniversity Hospital, CologneCologneGermany
  3. 3.Division of Pediatric NephrologyUniversity Children’s HospitalJenaGermany
  4. 4.Hanover Medical SchoolHanoverGermany
  5. 5.Division of Pediatric NephrologyChildren’s HospitalMemmingenGermany
  6. 6.Division of Pediatric NephrologyUniversity Children’s HospitalMarburgGermany
  7. 7.Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center – University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
  8. 8.Department of Pediatrics, Second School of Medicine and Biomedical Center, Faculty of Medicine in PilsenCharles UniversityPragueCzech Republic

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