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ORIGINAL ARTICLE
Year : 2021  |  Volume : 15  |  Issue : 3  |  Page : 215-222

Value of ambulatory blood pressure monitoring in potential renal donors - A prospective observational study


Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India

Correspondence Address:
Dr. Mital Dipakkumar Parikh
A/5 Vrundavan Park Society, VIP Road, Karelibaug, Vadodara - 390 018, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_68_20

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Introduction: Hypertension is very common among urban as well as rural population. In our donor selection policy, uncontrolled hypertension or target organ damage is a contraindication to kidney donation. Studies of blood pressure (BP) response to unilateral nephrectomy in kidney donors in short- and long-term are needed. We studied BP in kidney donors by ambulatory BP monitoring (ABPM) and the effect of unilateral nephrectomy on BP in them for 1 year following kidney donation. Methodology: We enrolled 80 consenting kidney donors aged between 20 and 65 years and followed them serially at pre, 6, and 12 months postkidney donation. Estimated glomerular filtration rate (eGFR) was measured using chronic kidney disease exocrine pancreatic insufficiency (CKD EPI) formula. BP was measured in the clinic (sphygmomanometer) and by ABPM (MeditechABPM05). eGFR, two-dimensional echocardiography, ophthalmological fundus examination, and 24 h proteinuria measurement were done at each visit. Results: There was a significant difference in predonation systolic BP by clinic and ABPM (138.07 + 5.5 vs. 117.17 + 10.2; P < 0.001) suggestive of white coat hypertension (WC) effect in 32 donors (40%) which decreased to only 21 (26.25%) donors having WC effect at 12 months of follow-up. There was masked hypertension (MH) in total 3 (3.75%) donors with sustained hypertension (SH) in 10 (12.5%) donors. BP was stable by ABPM till 1-year postdonation. Mean systolic and diastolic BP by ABPM was significantly higher in SH and MH groups as compared to WC and sustained normotensives. Baseline predonation eGFR measured by CKD-EPI was 106.0 + 12.35. eGFR decreased to 80.15 ± 15.76, i.e. 76% of the baseline eGFR. Hypertension by ABPM at baseline was associated with more decrease in the eGFR at 1 year of follow-up particularly in those with age > 50 years and higher body mass index. Proteinuria increased from the baseline value of 82.7 ± 29.94–104.07 ± 49.36 mg/day at 1 year of follow-up. Conclusions: ABPM provides a more accurate and reproducible estimate of BP compared to clinic BP to rule out WC hypertension and MH in kidney donors. Unilateral nephrectomy has no significant impact on kidney function or proteinuria over 1 year.


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