Nephrol Dial Transplant (2004) 19: 714-719
Nephrol Dial Transplant Vol. 19 No. 3 (c) ERA-EDTA 2004; all rights reserved
Brief Report
Review of clinical outcomes in nocturnal haemodialysis patients after renal transplantation
1Division of Nephrology, Toronto General Hospital, 2Division of Nephrology, Humber River Regional Hospital and 3Division of Nephrology, St Michael's Hospital, University of Toronto, Ontario, Canada
Correspondence and offprint requests to: Dr Christopher T. Chan, 200 Elizabeth Street, 12-EN 226, Toronto, ON M5G 2C4, Canada. Email: christopher.chan{at}uhn.on.ca
Background. Nocturnal haemodialysis (NHD) is a novel form of haemodialysis therapy that is associated with improved blood pressure control when compared to conventional haemodialysis (CHD). Current studies suggest that NHD lowers blood pressure through a decrease in peripheral resistance. The graft and blood pressure outcomes of NHD patients who undergo renal transplantation are unknown.
Methods. We reviewed the renal allograft and blood pressure outcomes of 15 NHD patients who underwent renal transplantation. An age and vintage matched cohort of 29 CHD patients was used as controls.
Results. The rate of delayed graft function (DGF) tended to be higher in the NHD group compared to the CHD group (64 vs 41%, P = 0.15), however the 1-year graft function (53±6 vs 59±5 ml/min, P = 0.426) and graft survival (92 vs 95%, P = 0.751) were similar. Intra-operatively, NHD patients had lower minimum systolic (92±5 vs 109±4, P = 0.03) and diastolic (48±3 vs 64±2, P = 0.02) blood pressures in comparison to the CHD cohort. Pathologically, acute tubular necrosis accounted for 100% of DGF in the NHD group in contrast to 75% in the CHD population (P = 0.01). Pre-transplant mean systolic BP (sBP) was significantly lower in the NHD group compared to the CHD group (113±6 vs 145±10 mmHg, P<0.001). At 12 months post-transplant, mean sBP increased from baseline in the NHD group (
sBP 22±7 mmHg, P = 0.009) while in the CHD group mean sBP fell (sBP –14±5 mmHg, P = 0.014). Mean arterial and diastolic BP exhibited similar changes. These trends persisted after 24 months of post-transplant follow-up.
Conclusions. One-year graft outcomes and blood pressures are similar for NHD and CHD patients who undergo renal transplantation. Unlike CHD patients, NHD patients experienced a significant fall in their intra-operative blood pressures, which likely contributed towards the delayed graft function in this cohort of patients. Further prospective studies are needed to examine the underlying differences in haemodynamics and long-term graft survival between the two renal replacement modalities.
Keywords: blood pressure; home haemodialysis; nocturnal home haemodialysis; renal transplantation