IMPACT OF AMBULATORY BLOOD PRESSURE MONITORING ON LIVING KIDNEY DONATION

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。在美国，大约三分之一的肾脏移植手术使用的是活体捐赠者的肾脏。潜在供体的高血压通常被认为是活体肾脏捐献的禁忌症，因为人们担心，尽管从未得到证实，这可能会增加肾脏疾病的风险，并使供体的高血压恶化。动态血压监测（ABPM）在24小时内多次测量血压，同时患者佩戴一个小型便携式监测仪并进行他或她的日常活动。ABPM已被证明能更好地测量一个人的真实血压。我们建议比较临床血压和ABPM，以确定ABPM记录改变高血压或正常血压诊断的频率。识别“白大褂高血压”病例——在医生办公室里血压很高，但其他方面正常——可以扩大潜在的活体供体库，而识别被一次临床读数遗漏的真正的高血压病例可以保护潜在的供体免于进行可能有害的手术。虽然有几项研究评估了活体肾脏捐赠者捐赠后的情况，但没有一项研究跟踪了捐赠者从移植前开始的情况。回顾过去的研究提供的信息有限，因为任何群体中都有很高比例的前捐赠者没有被包括在内，也因为没有办法将捐赠前的个人特征与患者的表现进行比较。我们建议在移植后6个月检查ABPM记录和肾脏疾病标志物，以监测这些值的变化。此外，我们将确定ABPM记录的模式是否会影响这些变化。对大多数人来说，夜间血压比白天低10- 20%。这种现象被称为“浸渍”，没有浸渍与高血压和糖尿病患者肾脏疾病恶化有关。我们建议获得移植前后受者的ABPM记录，以确定活体供体的浸渍状态是否对移植受者的浸渍状态或移植后受者高血压的严重程度有影响。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Roughly one-third of kidney transplants performed in the United States use kidneys from living donors. High blood pressure in a potential donor is generally considered to be a contraindication to living kidney donation because there is concern, though never proven, that this may increase the risk of kidney disease and worsened high blood pressure in the donor. Ambulatory blood pressure monitoring (ABPM) measures blood pressure multiple times over 24 hours while a patient wears a small, portable monitor and performs his or her usual activities. ABPM has been shown to be better at measuring a person's true blood pressure. We propose comparing clinic blood pressure and ABPM to determine the frequency with which the diagnosis of high blood pressure or normal blood pressure is changed by the ABPM recordings. Identifying cases of "white coat hypertension"- blood pressure that is high in the doctor's office but otherwise normal- can expand the potential living donor pool, while identifying true cases of high blood pressure that were missed by a single clinic reading can protect potential donors from proceeding with a potentially harmful surgery. Though there are several studies evaluating living kidney donors after donation, no study has followed donors from the time prior to transplant. The studies that look back in time provide limited information because a high percentage of former donors within any group are not included and because there is no way to compare individual characteristics before donation with how well patients do. We propose examining ABPM recordings and markers of kidney disease at 6 month intervals following transplant to monitor changes in these values. Further, we will determine if patterns of ABPM recordings affect these changes. In most people, nighttime blood pressure is 10-20 percent lower than daytime blood pressure. This phenomenon is called "dipping" and the absence of dipping is associated with worsened kidney disease in patients with high blood pressure and diabetes. We propose obtaining ABPM recordings in transplant recipients both before and after transplant to determine whether the dipping status of the living donor has any effect on the dipping status of the transplant recipient or on the severity of high blood pressure in the recipient after transplant.