Background

After kidney transplantation (KT), many end-stage renal disease (ESRD) patients showed well controlled blood pressure compared to before KT, but the effect of KT on circadian rhythm has not been fully investigated. The aim of this study is to investigate the change of blood pressure and circadian rhythm in ESRD patients after KT.

Methods

Twenty-seven patients who took ambulatory blood pressure monitoring (ABPM) before KT and 1 year after KT. All patients were followed up for at least 1 year. According to the nocturnal reduction of systolic blood pressure(SBP), dipper(ΔSBP ≥10%), non-dipper (0 < ΔSBP ≤10%), and reverse dipper (SBP nocturnal rise) pattern were defined. We investigated blood pressure, anti-hypertensive medication and circadian rhythm both before KT and at 1year after KT.

Results

Proportion of hypertensive patients was decreased from 85 % (23/27) to 37 % (10/27) after KT. The proportion of patients with uncontrolled hypertension (>140 / 90 mmHg with anti-hypertension medication) was decreased from 25% (7/27) to 4% (1/27) after KT. Mean blood pressure in 24 hours ABPM declined after KT from 126.9±19.2/83.5±12.6 to 119.7±8.3/81±7.5mmHg. Number of anti-hypertensive medication significantly decreased as well ; it was 1.9 ± 1.35 before KT and 0.5 ±0.8 after KT. However, circadian rhythm showed deteriorating pattern. Five out of twenty-seven (18%) patients were dippers before KT, however, it decreased to only 7% (2 / 27) and the reverse dippers were increased from 21%(6/27) to 32%(9/27) post-transplant 1 year.

Conclusions

The overall blood pressure improved; the proportion of hypertension decreased and anti-hypertensive medication was successfully weaned off in some patients after kidney transplantation. However, abnormal circadian rhythm does not improve in most patients even after kidney transplantation.

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