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: 7953663
• 负责人: Elizabeth Ommen
• 金额: $ 0.91万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7953663
• 关键词: Affect; Ambulatory Blood Pressure Monitoring; Back; Blood Pressure; Characteristics; Clinic; Clinical Research; Computer Retrieval of Information on Scientific Projects Database; Diabetes Mellitus; Diagnosis; Frequencies; Funding; Grant; Hour; Hypertension; Individual; Institution; Kidney; Kidney Diseases; Kidney Transplantation; Life; Living Donors; Measures; Monitor; Operative Surgical Procedures; Patients; Pattern; Persons; Reading; Research; Research Personnel; Resources; Risk; Severities; Source; Time; Transplant Recipients; Transplantation; United States; United States National Institutes of Health; white coat hypertension

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.

该子项目是利用该技术的众多研究子项目之一 资源由 NIH/NCRR 资助的中心拨款提供。子项目和 研究者 (PI) 可能已从 NIH 的另一个来源获得主要资金， 因此可以在其他 CRISP 条目中表示。列出的机构是 对于中心来说，它不一定是研究者的机构。 在美国进行的肾移植中，大约有三分之一使用来自活体捐赠者的肾脏。 潜在捐献者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，这可能会增加捐献者患肾脏疾病的风险并使高血压恶化。动态血压监测 (ABPM) 在患者佩戴小型便携式监测仪并进行日常活动时，在 24 小时内多次测量血压。 ABPM 已被证明可以更好地测量一个人的真实血压。我们建议比较诊所血压和 ABPM，以确定 ABPM 记录改变高血压或正常血压诊断的频率。识别“白大衣高血压”病例（在医生办公室血压很高，但其他方面正常）可以扩大潜在的活体捐赠者库，同时识别单次诊所读数漏掉的真实高血压病例可以保护潜在捐赠者免于进行可能有害的手术。 尽管有几项研究在捐献后评估活体肾脏捐献者，但没有研究从移植前的时间开始跟踪捐献者。回顾过去的研究提供的信息有限，因为任何群体中很大比例的前捐赠者都没有被包括在内，而且因为无法将捐赠前的个人特征与患者的表现进行比较。 我们建议在移植后每隔 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。 对于大多数人来说，夜间血压比白天血压低 10-20%。这种现象称为“浸渍”，没有浸渍与高血压和糖尿病患者的肾脏疾病恶化有关。我们建议在移植前和移植后获取移植受者的 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。