IMPACT OF AMBULATORY BLOOD PRESSURE MONITORING ON LIVING KIDNEY DONATION

动态血压监测对活体肾捐献的影响

• 批准号: 7380534
• 负责人: Elizabeth Ommen
• 金额: $ 5.47万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-17 至 2007-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7380534
• 关键词: blood pressure; hypertension; kidney

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.

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。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。潜在捐赠者的高血压通常被认为是活体肾脏捐赠的禁忌症，因为有人担心，尽管从未得到证实，但这可能会增加捐赠者患肾脏疾病的风险，并加剧捐赠者的高血压。动态血压监测(ABPM)在患者佩戴小型便携式监护仪进行日常活动时，在24小时内多次测量血压。ABPM已经被证明在测量一个人的真实血压方面更好。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--医生办公室里血压偏高，但其他方面正常--可以扩大潜在的活体捐赠者人库，而识别真正的高血压病例，只要一次临床阅读就能漏掉，就可以保护潜在的捐赠者，使其免受潜在的有害手术。虽然有几项研究评估了捐献后的活体肾脏捐赠者，但还没有研究跟踪捐赠者在移植前的时间。回顾过去的研究提供的信息有限，因为任何群体中的前捐赠者都不包括在内，而且无法将捐献前的个人特征与患者的表现进行比较。我们建议在移植后每隔6个月检查一次ABPM记录和肾脏疾病标记物，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。在大多数人中，夜间血压比白天血压低10%-20%。这种现象被称为“浸泡”，在高血压和糖尿病患者中，没有浸泡与肾脏疾病恶化有关。我们建议获取移植受者移植前和移植后的ABPM记录，以确定活体供者的浸泡状态是否对移植受者的浸泡状态或移植后受者高血压的严重程度有任何影响。