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NDT Advance Access originally published online on January 14, 2009
Nephrology Dialysis Transplantation 2009 24(4):1305-1313; doi:10.1093/ndt/gfn732
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Restoration of baroreflex function in patients with end-stage renal disease after renal transplantation

Dvora Rubinger, Rebecca Backenroth and Dan Sapoznikov

Nephrology and Hypertension Services, Hadassah University Medical Center, Jerusalem, Israel

Correspondence and offprint requests to: Dvora Rubinger, Nephrology and Hypertension Services, Hadassah University Medical Center, Ein Kerem P O Box 12000, Jerusalem 91120, Israel. Tel: +972-2-6776881, 972-2-6776589, 972-507874743; Fax: +972-2-6427260; E-mail: rdvora{at}hadassah.org.ils



  Abstract

Background. Renal transplantation improves the uraemic autonomic dysfunction and heart rate variability (HRV). The effects of successful transplantation on blood pressure variability (BPV) and baroreflex function are not well defined.

Methods. BPV, HRV and baroreceptor indices were determined in (1) 52 non-diabetic chronic haemodialysis patients, (2) 44 transplanted patients, 24 in the first year after renal transplantation (≤1 year) and 20 at least 1 year (>1 year) after renal transplantation, and (3) 41 control individuals with normal renal function, age-matched to (1) and (2). Power spectrum analysis of interbeat intervals (IBI) and systolic blood pressure (SBP) was performed in the low-frequency (LF 0.04–0.15 Hz) and the high-frequency (HF 0.15–0.40 Hz) bands. Spontaneous baroreceptor sensitivity (BRS) was determined by the sequence (slope) and spectral ({alpha} coefficient) techniques.

Results. In haemodialysis patients, BPV was increased, while HRV, BRS slope and LF {alpha} and HF {alpha} coefficients were markedly decreased as compared to control individuals. Renal transplantation was associated with normalization of BPV at short term (≤1 year) and long term and with improvement of HRV at a long-term (>1 year) follow-up. In patients with long-standing functioning grafts (>1 year), baroreceptor indices were significantly increased and returned to values similar to those of the control subjects.

Conclusions. Our data show that renal transplantation improves blood pressure and HRV and restores baroreflex function to near normal range on the long-term follow-up. These effects may contribute to the improvement of blood pressure control and survival after successful transplantation.

Keywords: baroreflex; blood pressure variability; haemodialysis; heart rate variability; transplantation

Received for publication: 16. 3.08
Accepted in revised form: 8.12.08


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