Kidney Week

Abstract: FR-PO1167

Changes in Blood Pressure, Graft Function, and Proteinuria After Dialysis Arteriovenous Fistula Closure in Kidney Transplant Recipients

Session Information

• Transplantation: Clinical - Post-Transplant Complications
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Vajdic trampuz, Barbara, University Medical Centre Ljubljana, Ljubljana, Slovenia

Barbara Vajdic trampuz,

• Arnol, Miha, University Medical Centre Ljubljana, Ljubljana, Slovenia

Miha Arnol,

• Buturovic-Ponikvar, Jadranka, University Medical Centre Ljubljana, Ljubljana, Slovenia

Jadranka Buturovic-Ponikvar,

Background

The aim of our observational historic cohort study was to evaluate the impact of dialysis arteriovenous fistula (AVF) closure on systolic and diastolic blood pressure (SBP, DBP), graft function and proteinuria in kidney transplant recipients.

Methods

The study group included 111 kidney transplant recipients with an AVF closure after a median 34 months’ post-transplant. Controls included 53 recipients with a functioning AVF after a median 33 months of follow-up. Graft function was assessed by serum creatinine and estimated glomerular filtration rate (eGFR) using CKD-EPI formula, and proteinuria was assessed by spot urine protein/creatinine ratio. SBP and DBP was measured at each visit. We used linear mixed models to calculate the slope of serum creatinine, eGFR and proteinuria change versus time.

Results

Baseline mean SBP and DBP were comparable between groups (134±16 vs. 138±16 mmHg; P=0.150, and 79±10 vs. 77±13 mmHg; P=0.472). Following AVF closure, SBP increased from 134±16 to 138±15 mmHg (P=0.001), and DBP increased from 79±10 to 84±10 mmHg (P<0.001). In the control group with functioning AVF SBP decreased (138±16 to 135±15 mmHg; P=0.038), while DBP did not change (77±13 to 76±11 mmHg; P=0.122). The course of serum creatinine and proteinuria and 95% confidence intervals are shown in Figure 1. The mean eGFR slope improved before (0.224 mL/min/1.73m² per month) and deteriorated after AVF closure (-0.023 mL/min/1.73m² per month) (P=0.044). The groups were significantly different with respect to serum creatinine slope (primary study end point; P=0.013) but not with respect to proteinuria slope (P=0.117).

Conclusion

The closure of a dialysis AVF may affect blood pressure and kidney graft function, but it does not impact proteinuria.