EVOLUTION OF RESERVOIR-WAVE ANALYSIS PARAMETERS AFTER KIDNEY TRANSPLANTATION. (April 2021)

• Record Type: Journal Article
• Authors: Côté, Nadège; Philibert, Emy; Paré, Mathilde; Goupil, Rémi; Fortier, Catherine; Schultz, Martin G.; Sharman, James E.; Agharazii, Mohsen
• Is Part Of: Journal of hypertension. Volume 39(2021)e-Supplement 1
• Publication Date: 2021-04
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000748032.89668.28
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: According to reservoir-wave analysis (RWA) arterial pressure is the sum of a reservoir pressure (RP) accounting for dynamic storage and release of blood from arteries, and an excess pressure (XSP) analogous to flow. RP is the minimal left ventricular work required to generate aortic flow, while XSP corresponds to surplus cardiac workload. We have previously shown that kidney transplantation (KTx) improves aortic stiffness. We now aim to determine how the improvement of aortic stiffness after kidney transplantation will translate on the reservoir-wave analysis parameters. We hypothesize that kidney transplantation will result in a decrease of excess pressure and of its integral. Design and method: This is a longitudinal observational study involving patients with kidney failure who were undergoing KTx. Before, 3, 6 and 24 months after KTx, carotid pressure waves were recorded using applanation tonometry, calibrated using brachial diastolic and mean blood pressure. Using pressure only approach, reservoir-wave analysis was used to derive RP, XSP and their integrals (RPI, XSPI). Results: 75 patients (69% male, mean age 51 ± 13 years) were assessed. Post-KTx, PR (121.4 ± 2.4 vs. 98.1 ± 1.5; P < 0.001) and PRI (11, 192.5[10, 515.7–11, 869.4] P < 0.001) decrease significantly and continuously. XSP (18.8 ± 1.1 vs. 18.6 ± 1.5; P = 0.898) doesn't decrease significantly. XSPI (390.9[331.4–450.4] P = 0.023) decreases significantly at 6 months post KTx but increases after. Conclusions: Kidney transplantation results in a continuous decrease of reservoir pressure and of its integral (RP and RPI). As opposed to our hypothesis, the excess pressure (XSP) does not decrease. XSP is analogous to flow. Therefore, it is possible that adding renal vessels to existing vascular network during KTx increases cardiac output. This could explain why we do not see a decrease of excess pressure post KTx despite reduced arterial stiffness.