PREVALENCE AND TREATMENT OF HYPERTENSION IN ELDERLY KIDNEY TRANSPLANT RECIPIENTS

Transcription

1 PREVALENCE AND TREATMENT OF HYPERTENSION IN ELDERLY KIDNEY TRANSPLANT RECIPIENTS Zbigniew Heleniak, Izabella Kuźmiuk, Hanna Garnier, Jakub Wiśniewski, Dorota Adrych, Przemysław Rutkowski, Leszek Tylicki, Bolesław Rutkowski, Alicja Dębska-Ślizień Department of Nephrology, Transplantology and Internal Diseases Medical University of Gdańsk

2 INTRODUCTION HYPERTENSION 32% of adults (age <80 years) in genaral population (NATPOL 2011) vs. 60 up to 85% of Kidney Transplant Recepients (KTR)

3 RISK FACTORS AND PATHOGENESIS OF HYPERTENSION AFTER RENAL TRANSPLANTATION ALLOGRAFT DYSFUNCTION IMMUNOSUPPRESSIVE THERAPY (Calcineurin inhibitors CI: CsA>TAC glucocorticoid therapy) RENAL ARTERY STENOSIS (<7%) INCREASED BODY WEIGHT DELAYED ALLOGRAFT FUNCTION DECEASED- DONOR ALLOGRAFT HYPERCALCEMIA POLICYTHEMIA GENETIC FACTORS donor with a family history of hypertension PRESENCE OF NATIVE KIDNEY Am J Kidney Dis. 2011;57(2):

4 ROLE OF THE IMMUNOSUPPRESSIVE THERAPY IN HYPERTENSION DEVELOPMENT Type of drug glucocorticoids CsA TAC AZA MMF/MPS Sirolimus Side effects weight gain, hyperglycemia and glucose intolerance, hypokalemia, gastrointestinal ulceration, Cushingoid appearance, hirsutism, impotence, menstrual irregularities, cataracts and increased intraocular pressure/glaucoma, myopathy, osteoporosis, HYPERTENSION Elevations in serum creatinine and BUN, hyperuricemia, renal insufficiency, HYPERTENSION!, seizures, paresthesias,depression, hypertrichosis, elevated bilirubin, serum transaminases, anemia, leukopenia, hyperkalemia HYPERTENSION, diarrhea, hyperglycemia, anemia, headache, tremor, insomnia, pain, and asthenia Bone marrow supression, bone marrow aplasia, gastrointestinal side effects, Cervical cancer, Kaposi's sarcoma, non-hodgkin's lymphoma, squamous cell carcinoma of the skin, vulval cancer Gastrointestinal side effects, leukopenia, anemia, lymphoma, dermatologic, urinary and matabolic side effects Respiratory side effects, peripheral edema, hyperlipidemia, hypercholesterolemia, increased creatinine, HYPERTENSION and chest pain, dirrhoea, constipation, anemia, genitorinary, musculaskeletal, nervous side effects Table 1. The side effects of the most commonly used immunosuppressive agents

5 MECHANISMS OF HYPERTENSION DEVELOPMENT IN THE GROUP OF KTR Am J Kidney Dis. 2011;57(2):

6 CLINICAL IMPLICATIONS OF HA HYPERTENSION DECREASED ALLOGRAFT SURVIVAL CHRONIC ALLOGRAFT INJURY LEFT VENTRICULAR HYPERTROPHY ALLOGRAFT FAILURE HEART FAILURE DEATH

7 WHAT ARE THE GOALS OF ANTIHYPERTENSIVE THERAPY? The target blood pressure depends on: - absence or presence of proteinuria - additional conditions THERAPY ADMINISTERED IF BLOOD PRESSURE 140/90 Well controlled hypertension (ESH/ESC 2013) patients WITH proteinuria (,,nephro target ) (total protein to creatinine ratio of 500 t mg/g) patients WITHOUT proteinuria < 130/80 <140/90 Mancia et al.; Jouranal of Hypertension 2013, 13:

8 AIM OF THE STUDY cross-sectional observational study Evaluation of the pharmacotherapy of hypertension in Kidney Transplant Recepients (KTR)

9 MATERIAL AND METHODS group of 861 patients 335F / 526M with a mean age of 52,6 years (62% age < 60 years old, 38%> 60 y.o.) after kidney transplantation (in years ) under control of University Outpatient Transplantation Clinic in 2014

10 PRESENCE OF HA OR THE NEED OF THE ANTIHYPERTENSIVE TREATMENT Figure 1. Presence of HA or the need of the hypotensive treatment in KTRs in 2014

11 TYPE OF DRUGS THE MOST COMMONLY USED TYPES OF THE ANTIHYPERTENSIVE DRUGS (Tab.2) PERCENTAGE OF PATIENTS [%] young group PERCENTAGE OF PATIENTS [%] old group BETA-BLOCKERS 83 (1) 83 (1) CALCIUM CHANEL BLOCKERS 54 (2) 54 (2) RAA-INHIBITORS 40 (3) 48 (4) ACE-INHIBITORS ARBs 7 7 ALDOSTERONE ANTAGONISTS 4 4 DIURETICS 30(4) 51(3) LOOP DIURETICS THIAZIDE DIURETICS 1 1 ALPHA RECEPTOR BLOCKERS 32 (5) 48 (4) METHYLDOPA 2 2 CLONIDINE 5 5 HYDRALAZINE/MINOXIDIL 0 0

12 Percentage of patients using single, double, triple and multidrug therapy 26% 24% 23% 27% young group 2>3>multidrug>1 old group 26% 32% 14% 28% 3>2>multidrug>1

13 β -blocker+ccb β -blocker+acei β -blocker+diuretics

14 CONCLUSIONS 1. Hypertension is one of the most common comorbidities in the group of KTRs. 2. The most frequently used antihypertensive drugs were: β-blockers, calcium antagonists and diuretics and the most common therapy includes three antihypertensive agents in the older KTRs. 3. Diuretics and α-blockers are more frequently used in the group of older KTRs.

15 THANK YOU FOR YOUR ATTENTION!