Predictive factors of post-transplant hypertension in kidney transplant recipients

Introduction: Hypertension after kidney transplantation has been identified as an important risk factor for chronic allograft injury. Objective: The present study aimed to determine the prevalence and possible risk factors for posttransplant hypertension. Methods: A retrospective cohort study was conducted at our kidney transplantation unit between January 1, 2007 and August 19, 2022, by including patients who regularly underwent home blood pressure monitoring. The recipient's demographic information, laboratory data, and donor characteristics were collected at 6 and 12 months after transplantation. Blood pressure thresholds were defined according to the European Society of Hypertension (ESH) guidelines. Logistic regression was used to estimate both the unadjusted and adjusted odds ratio to identify the potential risk factors for posttransplant hypertonia and multiple imputation was used for missing data of the donors. Results: 280 patients were included in this study. The overall prevalence of hypertension was found to be 49.3% and 53.5% at 6 and 12 months after kidney transplantation, respectively. After multivariable adjustment, the predictive factors for hypertension 6 months after kidney transplantation were male gender (OR: 1.717, 95% CI: 1.007-2.927; p = 0.047) and donor with a medical history of hypertension (OR: 2.038, 95% CI: 1.038-4.004; p = 0.039). However, serum uric acid level (OR: 1.004, 95% CI: 1.000-1.007; p = 0.033) and male gender (OR: 2.048, 95% CI: 1.161-3.614; p = 0.013) were independent risk factors at 12 months. Discussion: The prevalence of hypertension is high among kidney-transplant recipients. Our study suggests that male gender, hypertensive donor, and serum uric acid level are the potential predictors of hypertension after kidney transplantation. Conclusion: Unrecognized and untreated post transplant hypertension leads to functional deterioration of the allograft, thereby reducing graft survival.