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Abstract: FR-PO1052

Postural Blood Pressure Control Is Decreased in Diabetic Patients After Successful Renal Transplantation

Session Information

Category: Hypertension and CVD

  • 1403 Hypertension and CVD: Mechanisms

Authors

  • Rubinger, Dvora, Hadassah Hebrew University Medical Center, Jerusalem, Israel
  • Dranitzki Elhalel, Michal, Hadassah Hebrew University Medical Center, Jerusalem, Israel
  • Sapoznikov, Dan, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Background

The postural control of blood pressure (BP) under othostatic challenges, a measure of the robustness of the autonomic nervous system, is reduced in both renal insufficiency and diabetes mellitus (DM).The present study was undertaken to assess the effect of normalization of kidney function by renal transplantation (TX) on postural changes of BP and autonomic indices in uremic patients, without [DM(-)] and with [DM(+)].

Methods

Continuous interbeat interval (IBI), systolic (SBP) and diastolic (DBP) BP and their variabilities in the low (LF) and high (HF) frequency ranges were recorded during sitting and standing in 48 TX DM(-), in 14 TX DM(+) patients and in 37 control (C) individuals of similar age range. α index, a measure of baroreflex function was obtained from the square roots of the ratio of average IBI and SBP powers. LF IBI/HF IBI was considered a measure of the sympatho-vagal balance.

Results

Plasma creatinine was 116±31 and 113±43 μmol/l in TX DM(-) and TX DM(+) respectively (pNS). Differences (Δ) in BP and variability measures between sitting and standing positions (median and interquartile ranges) are shown in Table1. In C, moving from sitting to standing was associated with increased BP, decreased IBI, decreased α indices and increased sympatho-vagal balance. These changes were partly maintained in TX DM (-) but markedly suppressed in TX DM (+).

Conclusion

Our data show that in C, BP during postural changes is maintained by sympathetic activation, which is partialy attenuated in TX DM (-) and almost abolished in TX DM(+), despite the reversal of renal failure.These alterations, arguably the consequence of long standing DM autonomic neuropathy, may be responsible for frailty, gait instability and falls in these patients.

Table 1.
 CTX DM (-)p vs.CTX DM (+)p vs. C
Δ SBP (mmHg)9.7 (16.2)8.9 (18.1)0.818-1.6 (32.4)0.045
Δ DBP (mmHg)9.6 (11.3)10.8 (11.0)0.6971.6 (9.1)0.008
Δ IBI (ms)-78 (82)-58 (81)0.111-45 (67)0.028
Δ LF SBP (mmHg2//Hz)103 (117)47 (90)0.00219 (64)0.002
Δ HF SBP (mmHg2//Hz)17.7 (35.1)10.5 (22.9)0.0893.6 (20.2)0.018
Δ LF IBI (ms2/Hz)597(2445)-79 (1347)0.018-0.8 (139)0.076
Δ HF IBI (ms2/Hz)-122 (928}-57 (505)0.484-22 (61)0.047
Δ LF α (ms/mmHg)-1.68 (2.16)-1.21 (2.10)0.405-0.52 (0.83)0.002
Δ HF α (ms/mmHg)-3.40 (4.54)-2.07 (4.36)0.072-0.27 (1.53)0.001
Δ (LF IBI/HF IBI)1.51(3.92)0.39 (2.53)0.0010.06 (2.01)0.002

Δ: difference of standing- sitting measurements.