Longitudinal relations between obesity and hypertension following pediatric renal transplantation

被引:18
作者
Denburg, Michelle R. [1 ]
Pradhan, Madhura [1 ]
Shults, Justine [2 ]
Jones, Abigail [1 ]
Palmer, Jo Ann [1 ]
Baluarte, H. Jorge [1 ]
Leonard, Mary B. [1 ,2 ]
机构
[1] Childrens Hosp Philadelphia, Dept Pediat, Div Nephrol, Philadelphia, PA 19104 USA
[2] Univ Penn, Sch Med, Dept Epidemiol & Biostat, Philadelphia, PA 19104 USA
关键词
Obesity; Hypertension; Renal transplant; Children; Glucocorticoid; BODY-MASS INDEX; LEFT-VENTRICULAR HYPERTROPHY; BLOOD-PRESSURE; YOUNG-ADULTS; KIDNEY-TRANSPLANTATION; DUTCH COHORT; CARDIOVASCULAR-DISEASE; ALLOGRAFT RECIPIENTS; METABOLIC SYNDROME; RANDOMIZED-TRIAL;
D O I
10.1007/s00467-010-1572-4
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Obesity and hypertension frequently complicate renal transplantation (RTxp). The objective was to assess relations among obesity, hypertension, and glucocorticoids in pediatric RTxp recipients. A retrospective cohort study was carried out in 141 RTxp recipients, 2-21 years of age, with a parts per thousand yen12 months of follow-up. Body mass index Z-score (BMI-Z), systolic and diastolic blood pressure Z-scores (SBP-Z and DBP-Z), and medications at 1, 3, 6, and 12 months and annually thereafter were recorded. Quasi-least squares regression analysis was used. The prevalence of obesity (BMI a parts per thousand yenaEuro parts per thousand 95th percentile) increased from 13% at baseline to > 30% from 3 months onward. Greater glucocorticoid exposure (mg/kg/day) was associated with greater increases in BMI-Z (p < 0.001). This association was greater in males, younger recipients, and those with lower baseline BMI-Z (all interactions p < 0.02). The prevalence of systolic hypertension (SBP a parts per thousand yenaEuro parts per thousand 95th percentile) was 73% at 1 month and a parts per thousand yenaEuro parts per thousand 40% at all follow-up visits. Greater glucocorticoid exposure (p < 0.001) and increases in BMI-Z (p = 0.005) were independent determinants of SBP-Z over time. Cyclosporine (versus tacrolimus) was independently associated with greater SBP-Z and DBP-Z (p = 0.001). Sustained obesity and hypertension frequently complicated pediatric RTxp. Obesity was an independent determinant of systolic hypertension. Strategies are needed to prevent obesity and its impact on hypertension, cardiovascular disease, and allograft survival.
引用
收藏
页码:2129 / 2139
页数:11
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