Hypertension in End-Stage Renal Disease: Transplantation

Living reference work entry
First Online:
Received:
Accepted:

Abstract

Hypertension in children after renal transplantation is an important risk factor not only for graft loss but also for cardiovascular morbidity and mortality. The prevalence of posttransplant HTN ranges between 60% and 90%. The etiology of posttransplant HTN is multifactorial – chronic native kidney disease, immunosuppressive therapy, and chronic allograft dysfunction are the most common causes. Casual blood pressure (BP) should be measured at each outpatient visit; however, ambulatory blood pressure monitoring (ABPM) is the best method for BP evaluation in children after renal transplantation, as it often discloses especially nighttime HTN; given this, it should be regularly performed in each transplanted child. All classes of antihypertensive drugs are used in the treatment of posttransplant HTN because it has never been proven that one class would be better than another. The most commonly used antihypertensives are calcium channel blockers. The target BP for transplant children is still a matter of debate; it is recommended to target the same BP as for healthy children, i.e., <90th percentile. Control of HTN in transplanted children still remains poor – only 20–50% of treated children have normal BP. There is a great potential for improvement of antihypertensive treatment that could potentially result in improvement of both graft and patient survival in children after renal transplantation.

Keywords

Hypertension Blood pressure End-stage renal disease Children Kidney transplantation Cardiovascular morbidity and mortality Left ventricular hypertrophy 
This is a preview of subscription content, log in to check access.

References

  1. Arbeiter K, Pichler A, Stemberger R, Mueller T, Ruffingshofer D, Vargha R, Balzar E, Aufricht C (2004) ACE inhibition in the treatment of children after renal transplantation. Pediatr Nephrol 19:222–226CrossRefPubMedGoogle Scholar
  2. Bald M, Böhm W, Feldhoff C, Bonzel KE (2001) Home blood pressure self-measurement in children and adolescents with renal replacement therapy. Klin Padiatr 213:21–25CrossRefPubMedGoogle Scholar
  3. Baluarte HJ, Gruskin AB, Ingelfinger JR, Tejani A (1994) Analysis of hypertension in children post renal transplantation – a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Nephrol 8:570–573CrossRefPubMedGoogle Scholar
  4. Balzano R, Lindblad YT, Vavilis G, Jogestrand T, Berg UB, Krmar RT (2011) Use of annual ABPM, and repeated carotid scan and echocardiography to monitor cardiovascular health over nine yr in pediatric and young adult renal transplant recipients. Pediatr Transplant 15:635–641CrossRefPubMedGoogle Scholar
  5. Becker-Cohen R, Nir A, Ben-Shalom E, Rinat C, Feinstein S, Farber B, Frishberg Y (2008) Improved left ventricular mass index in children after renal transplantation. Pediatr Nephrol 23:1545–1550CrossRefPubMedGoogle Scholar
  6. Büscher R, Vester U, Wingen AM, Hoyer PF (2004) Pathomechanisms and the diagnosis of arterial hypertension in pediatric renal allograft recipients. Pediatr Nephrol 19:1202–1211CrossRefPubMedGoogle Scholar
  7. Calvino J, Lens XM, Romero R, Sánchez-Guisande D (2000) Long-term anti-proteinuric effect of losartan in renal transplant recipients treated for hypertension. Nephrol Dial Transplant 15:82–86CrossRefPubMedGoogle Scholar
  8. Cheigh JS, Haschemeyer RH, Wang JCL, Riggio RR, Tapia L, Stenzel KH, Rubin AL (1989) Hypertension in kidney transplant recipients. Effect on long-term renal allograft survival. Am J Hypertens 2:341–348PubMedGoogle Scholar
  9. Curtis JJ (1997) Treatment of hypertension in renal allograft patients: does drug selection make a difference. Kidney Int 52(Suppl 63):S75–S77Google Scholar
  10. Curtis JJ, Galla JH, Kotchen TA, Lucas B, McRoberts JW, Luke RG (1976) Prevalence of hypertension in a renal transplant population on alternate-day steroid therapy. Clin Nephrol 5:123–127PubMedGoogle Scholar
  11. Dvorakova HM, Szitanyi P, Dvorak P, Janda J, Seeman T, Zieg J, Lanska V, Kotaska K, Pitha J (2012) Determinants of premature atherosclerosis in children with end-stage renal disease. Physiol Res 61:53–61PubMedGoogle Scholar
  12. El-Husseini AA, Foda MA, Shokeir AA, Shebab El-Din AB, Sobh MA, Ghoneim MA (2005) Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: a single center experience. Pediatr Transplant 9:763–769CrossRefPubMedGoogle Scholar
  13. Flynn JT (2006) Hypertension and future cardiovascular disease in pediatric renal transplant recipients. Pediatr Transplant 10:276–278CrossRefPubMedGoogle Scholar
  14. Flynn JT (2012) Ambulatory blood pressure monitoring should be routinely performed after pediatric renal transplantation. Pediatr Transplant 16:533–536CrossRefPubMedGoogle Scholar
  15. Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M, Zachariah JP, Urbina EM (2014) Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 63:1116–1135CrossRefPubMedPubMedCentralGoogle Scholar
  16. Fung LC, McLorie GA, Khoury AR (1995) Donor aortic cuff reduces the rate of anastomotic arterial stenosis in pediatric renal transplantation. J Urol 154:909–913CrossRefPubMedGoogle Scholar
  17. Gordjani A, Offner G, Hoyer PF, Brodehl J (1990) Hypertension after renal transplantation in patients treated with cyclosporine and azathioprine. Arch Dis Child 65:275–279CrossRefPubMedPubMedCentralGoogle Scholar
  18. Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van De Kar NJ, Wolff ED, Davin JC, Heymans HS (2002) Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int 61:621–629CrossRefPubMedGoogle Scholar
  19. Hamdani G, Nehus EJ, Hanevold CD, Sebestyen Van Sickle J, Woroniecki R, Wenderfer SE, Hooper DK, Blowey D, Wilson A, Warady BA, Mitsnefes MM (2016) Ambulatory blood pressure, left ventricular hypertrophy, and allograft function in children and young adults after kidney transplantation. Transplantation. 18 Feb 2016 [Epub ahead of print]Google Scholar
  20. Hanevold CD, Ho PL, Talley L, Mitsnefes MM (2005) Obesity and renal transplant outcome: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatrics 115:352–356CrossRefPubMedGoogle Scholar
  21. Hausberg M, Barenbrock M, Hohage H, Müller S, Heidenreich S, Rahn KH (1999) ACE inhibitor versus β-blocker for the treatment of hypertension in renal allograft recipients. Hypertension 33:862–868CrossRefPubMedGoogle Scholar
  22. Heinze G, Mitterbauer C, Regele H, Kramar R, Winkelmayer WC, Curhan GC, Oberbauer R (2006) Angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor antagonist therapy is associated with prolonged patient and graft survival after renal transplantation. J Am Soc Nephrol 17:889–899CrossRefPubMedGoogle Scholar
  23. Hocker B, John U, Plank C, Wuhl E, Weber LT, Misselwitz J, Rascher W, Mehls O, Tonshoff B (2004) Successful withdrawal of steroids in pediatrics renal transplant recipients receiving cyclosporine A and mycophenolate mofetil treatment: results after four years. Transplantation 78:228–234CrossRefPubMedGoogle Scholar
  24. Höcker B, Weber LT, Feneberg R, Drube J, John U, Fehrenbach H, Pohl M, Zimmering M, Fründ S, Klaus G, Wühl E, Tönshoff B (2010) Improved growth and cardiovascular risk after late steroid withdrawal: 2-year results of a prospective, randomised trial in paediatric renal transplantation. Nephrol Dial Transplant 25:617–624CrossRefPubMedGoogle Scholar
  25. Hooper DK, Mitsnefes M (2015) A systems-based approach to managing blood pressure in children following kidney transplantation. Pediatr Nephrol. 19 Oct 2015 [Epub ahead of print]Google Scholar
  26. Jacobi J, Rockstroh J, John S, Schreiber M, Schlaich MP, Neumayer HH, Schmieder RE (2000) Prospective analysis of the value of 24-hour ambulatory blood pressure on renal function after kidney transplantation. Transplantation 70:819–827CrossRefPubMedGoogle Scholar
  27. Kaidar M, Berant M, Krauze I, Cleper R, Mor E, Bar-Nathan N, Davidovits M (2014) Cardiovascular risk factors in children after kidney transplantation – from short-term to long-term follow-up. Pediatr Transplant 18:23–28CrossRefPubMedGoogle Scholar
  28. Kasiske BL, Ballantyne CM (2002) Cardiovascular risk associated with immunosuppression in renal transplantation. Transplant Rev 16:1–21CrossRefGoogle Scholar
  29. Kasiske BL, Guijarro C, Massy ZA, Wiederkehr MR, Ma JZ (1996) Cardiovascular disease after renal transplantation. J Am Soc Nephrol 7:158–165PubMedGoogle Scholar
  30. Kis E, Cseprekál O, Horváth Z, Katona G, Fekete BC, Hrapka E, Szabó A, Szabó AJ, Fekete A, Reusz GS (2008) Pulse wave velocity in end-stage renal disease: influence of age and body dimensions. Pediatr Res 63:95–98CrossRefPubMedGoogle Scholar
  31. Kitzmueller E, Vécsei A, Pichler J, Bohm M, Muller T, Vargha R, Csaicsich D, Aufricht C (2004) Changes of blood pressure and left ventricular mass in pediatric renal transplantation. Pediatr Nephrol 19:1385–1389CrossRefPubMedGoogle Scholar
  32. Kramer AM, van Stralen KJ, Jager KJ, Schaefer F, Verrina E, Seeman T, Lewis MA, Boehm M, Simonetti GD, Novljan G, Groothoff JW (2011) Demographics of blood pressure and hypertension in children on renal replacement therapy in Europe. Kidney Int 80:1092–1098CrossRefPubMedGoogle Scholar
  33. Krmar RT, Berg UB (2005) Long-term reproducibility of routine ambulatory blood pressure monitoring in stable pediatric renal transplant recipients. Am J Hypertens 18:1408–1414CrossRefPubMedGoogle Scholar
  34. Lipkin GW, Tucker B, Giles M, Raine AE (1993) Ambulatory blood pressure and left ventricular mass in cyclosporin- and non-cyclosporin-treated renal transplant recipients. J Hypertens 11:439–442CrossRefPubMedGoogle Scholar
  35. Litwin M, Wuhl E, Jourdan C, Trelewicz J, Niemirska A, Fahr K, Jobs K, Grenda R, Waver ZT, Rajszys P, Troger J, Mehls O, Schaefer F (2005) Altered morphologic properties of large arteries in children with chronic renal failure and after renal transplantation. J Am Soc Nephrol 16:1494–1500CrossRefPubMedGoogle Scholar
  36. Lurbe E, Alvarez V, Liao Y, Tacons J, Cooper R, Cremades B, Torro I, Redon J (1998) The impact of obesity and body fat distribution on ambulatory blood pressure in children and adolescents. Am J Hypertens 11:418–424CrossRefPubMedGoogle Scholar
  37. Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, Kuznetsova T, Laurent S, Mancia G, Morales-Olivas F, Rascher W, Redon J, Schaefer F, Seeman T, Stergiou G, Wühl E, Zanchetti A, European Society of Hypertension (2009) Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens 27:1719–1742CrossRefPubMedGoogle Scholar
  38. Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, Invitti C, Litwin M, Mancia G, Pall D, Rascher W, Redon J, Schaefer F, Seeman T, Sinha M, Stabouli S, Webb NJ, Wühl E, Zanchetti A (2016) European Society of hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 1 Aug 2016 [Epub ahead of print]Google Scholar
  39. Matteucci MC, Giordano U, Calzolari A, Turchetta A, Santilli A, Rizzoni G (1999) Left ventricular hypertrophy, treadmill tests, and 24-hour blood pressure in pediatric transplant patients. Kidney Int 56:1566–1570CrossRefPubMedGoogle Scholar
  40. McGlothan KR, Wyatt RJ, Ault BH, Hastings MC, Rogers T, DiSessa T, Jones DP (2006) Predominance of nocturnal hypertension in pediatric renal allograft recipients. Pediatr Transplant 10:558–564CrossRefPubMedGoogle Scholar
  41. Mitsnefes MM, Portman RJ (2003) Ambulatory blood pressure monitoring in pediatric renal transplantation. Pediatr Transplant 7:86–92CrossRefPubMedGoogle Scholar
  42. Mitsnefes MM, Omoloja A, McEnery PT (2001) Short-term pediatric renal transplant survival: blood pressure and allograft function. Pediatr Transplant 5:160–165CrossRefPubMedGoogle Scholar
  43. Mitsnefes MM, Khoury PR, McEnery PT (2003) Early posttransplantation hypertension and poor long-term allograft survival in pediatric patients. J Pediatr 143:98–103CrossRefPubMedGoogle Scholar
  44. Mitsnefes MM, Kimball TR, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2004) Abnormal carotid artery structure and function in children and adolescents with successful renal transplantation. Circulation 110:97–101CrossRefPubMedGoogle Scholar
  45. Morgan H, Khan I, Hashmi A, Hebert D, Balfe JW (2001) Ambulatory blood pressure monitoring after renal transplantation in children. Pediatr Nephrol 16:843–847CrossRefPubMedGoogle Scholar
  46. Neale J, Smith AC, Bishop NC (2016) The effects of exercise and sport in solid organ transplant recipients: a review. Am J Phys Med Rehabil. 22 Aug 2016 [Epub ahead of print]Google Scholar
  47. Opelz G, Wujciak T, Ritz E, for the Collaborative Transplant Study (1998) Association of chronic kidney graft failure with recipient blood pressure. Kidney Int 53:217–222CrossRefPubMedGoogle Scholar
  48. Opelz G, Dohler B, Collaborative Transplant Study (2005) Improved long-term outcomes after renal transplantation associated with blood pressure control. Am J Transplant 5:2725–2731CrossRefPubMedGoogle Scholar
  49. Opelz G, Zeier M, Laux G, Morath C, Dohler B (2006) No improvement of patient or graft survival in transplant recipients treated with angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers: a Collaborative Transplant Study report. J Am Soc Nephrol 17:3257–3262CrossRefPubMedGoogle Scholar
  50. Ponticelli C, Glassock RJ (2010) Posttransplant recurrence of primary glomerulonephritis. Clin J Am Soc Nephrol 5:2363–2372CrossRefPubMedGoogle Scholar
  51. Sarwal MM, Ettenger R, Dharnidharka V, Benfield M, Mathias R, Portale A, McDonald R, Harmon W, Kershaw D, Vehaskari VM, Kamil E, Baluarte HJ, Warady B, Tang L, Liu J, Li L, Naesens M, Sigdel T, Waskerwitz J, Salvatierra O (2012) Complete steroid avoidance is effective and safe in children with renal transplants: a multicenter randomized trial with three-year follow-up. Am J Transplant 12:2719–2729CrossRefPubMedPubMedCentralGoogle Scholar
  52. Seeman T (2009) Hypertension after renal transplantation. Pediatr Nephrol 24:959–972CrossRefPubMedGoogle Scholar
  53. Seeman T (2012) Ambulatory blood pressure monitoring in pediatric renal transplantation. Curr Hypertens Rep 14:608–618CrossRefPubMedGoogle Scholar
  54. Seeman T, Šimková E, Kreisinger J, Vondrák K, Dušek J, Gilík J, Feber J, Dvořák P, Janda J (2006) Control of hypertension in children after renal transplantation. Pediatr Transplant 10:316–322CrossRefPubMedGoogle Scholar
  55. Seeman T, Šimková E, Kreisinger J, Vondrák K, Dušek J, Gilík J, Dvořák P, Janda J (2007) Improved control of hypertension in children after renal transplantation: results of a two-yr interventional trial. Pediatr Transplant 11:491–497CrossRefPubMedGoogle Scholar
  56. Seeman T, Dusek J, Vondrak K, Spatenka J, Feber J (2009) Profiling proteinuria in children after renal transplantation. Pediatr Nephrol 24:2439–2944CrossRefPubMedGoogle Scholar
  57. Seeman T, Dusek J, Vondrak K, Janda J (2010) Ramipril in the treatment of proteinuria in children after renal transplantation. Pediatr Transplant 14:283–287CrossRefPubMedGoogle Scholar
  58. Seeman T, Dusek J, Vondrak K, Simankova N, Zieg J (2015) ESCORT trial – effects of strict control of blood pressure in pediatric renal transplant recipients – 2 year results from a randomized controlled trial. Pediatr Nephrol 30:1562CrossRefGoogle Scholar
  59. Silverstein DM, Palmer J, Baluarte HJ, Brass C, Conley SB, Polinsky MS (1999) Use of calcium-channel blockers in pediatric renal transplant recipients. Pediatr Transplant 3:288–292CrossRefPubMedGoogle Scholar
  60. Simões E, Silva AC, Teixeira MM (2016) ACE inhibition, ACE2 and angiotensin-(1-7) axis in kidney and cardiac inflammation and fibrosis. Pharmacol Res 107:154–162CrossRefGoogle Scholar
  61. Sinha MD, Kerecuk L, Gilg J, Reid CJ, on behalf of the British Association for Paediatric Nephrology (2012) Systemic arterial hypertension in children following renal transplantation: prevalence and risk factors. Nephrol Dial Transplant 27:3359–3368CrossRefPubMedGoogle Scholar
  62. Sorof JM, Sullivan EK, Tejani A, Portman RJ (1999) Antihypertensive medication and renal allograft failure: a North American Pediatric Renal Transplant Cooperative Study report. J Am Soc Nephrol 10:1324–1330PubMedGoogle Scholar
  63. Stigant CE, Cohen J, Vivera M, Zaltzman JS (2000) ACE inhibitors and angiotensin II antagonists in renal transplantation: an analysis of safety and efficacy. Am J Kidney Dis 35:58–63CrossRefPubMedGoogle Scholar
  64. Sun N, Zhai L, Li H, Shi LH, Yao Z, Zhang B (2016) Angiotensin-Converting Enzyme Inhibitor (ACEI)-mediated amelioration in renal fibrosis involves suppression of mast cell degranulation. Kidney Blood Press Res 41:108–118CrossRefPubMedGoogle Scholar
  65. Suszynski TM, Rizzari MD, Gillingham KJ, Rheault MN, Kraszkiewicz W, Matas AJ, Chavers BM (2013) Antihypertensive pharmacotherapy and long-term outcomes in pediatric kidney transplantation. Clin Transplant 27:472–480CrossRefPubMedPubMedCentralGoogle Scholar
  66. Task force on cardiovascular disease (1998). Special report from the National Kidney Foundation. Am J Kidney Dis 32(Suppl 3):1–121.Google Scholar
  67. Trompeter R, Filler G, Webb NJ, Watson AR, Milford DV, Tyden G, Grenda R, Janda J, Hughes D, Ehrich JH, Klare B, Zacchello G, Bjorn Brekke I, McGraw M, Perner F, Ghio L, Balzar E, Friman S, Gusmano R, Stolpe J (2002) Randomized trial of tacrolimus versus cyclosporin microemulsion in renal transplantation. Pediatr Nephrol 17:141–149CrossRefPubMedGoogle Scholar
  68. Tutone VK, Mark PB, Stewart GA, Tan CC, Rodger RSC, Geddes CC, Jardine AG (2005) Hypertension, antihypertensive agents and outcomes following renal transplantation. Clin Transplant 19:181–192CrossRefPubMedGoogle Scholar
  69. Vianello A, Mastrosimone S, Calconi G, Gatti PL, Calzavara P, Maresca MC (1993) The role of hypertension as damaging factor for kidney grafts under cyclosporine therapy. Am J Kidney Dis 21(Suppl 1):79–83CrossRefPubMedGoogle Scholar
  70. Wilson AC, Mitsnefes MM (2009) Cardiovascular disease in CKD in children: update on risk factors, risk assessment, and management. Am J Kidney Dis 54:345–360CrossRefPubMedPubMedCentralGoogle Scholar
  71. Wilson AC, Greenbaum LA, Barletta GM, Chand D, Lin JJ, Patel HP, Mitsnefes M (2010) High prevalence of the metabolic syndrome and associated left ventricular hypertrophy in pediatric renal transplant recipients. Pediatr Transplant 14:52–60CrossRefPubMedGoogle Scholar
  72. Wühl E, Hadtstein C, Mehls O, Schaefer F, Escape Trial Group (2004) Home, clinic, and ambulatory blood pressure monitoring in children with chronic renal failure. Pediatr Res 55:492–497CrossRefPubMedGoogle Scholar
  73. Wuhl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, Zurowska A, Testa S, Jankauskiene A, Emre S, Caldas-Afonso A, Anarat A, Niaudet P, Mir S, Bakkaloglu A, Enke B, Montini G, Wingen AM, Sallay P, Jeck N, Berg U, Caliskan S, Wygoda S, Hohbach-Hohenfellner K, Dusek J, Urasinski T, Arbeiter K, Neuhaus T, Gellermann J, Drozdz D, Fischbach M, Möller K, Wigger M, Peruzzi L, Mehls O, Schaefer F (2009) Strict blood-pressure control and progression of renal failure in children. N Engl J Med 361:1639–1650CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Faculty of Medicine in Plzen, Department of Pediatrics and Transplantation Center, 2nd Medical Faculty and Biomedical CentreUniversity Hospital Motol, Charles University PraguePragueCzech Republic

Personalised recommendations