Steroid withdrawal improves blood pressure control and nocturnal dipping in pediatric renal transplant recipients: analysis of a prospective, randomized, controlled trial
Jazyk angličtina Země Německo Médium print-electronic
Typ dokumentu časopisecké články, randomizované kontrolované studie, práce podpořená grantem
PubMed
30178240
DOI
10.1007/s00467-018-4069-1
PII: 10.1007/s00467-018-4069-1
Knihovny.cz E-zdroje
- Klíčová slova
- Ambulatory blood pressure, Nocturnal blood pressure dipping, Pediatric renal transplantation, Randomized controlled trial, Steroid withdrawal,
- MeSH
- alografty imunologie patofyziologie MeSH
- ambulantní monitorování krevního tlaku MeSH
- cirkadiánní rytmus fyziologie MeSH
- cyklosporin aplikace a dávkování škodlivé účinky MeSH
- dítě MeSH
- glukokortikoidy aplikace a dávkování škodlivé účinky MeSH
- hodnoty glomerulární filtrace fyziologie MeSH
- homologní transplantace škodlivé účinky MeSH
- hypertenze chemicky indukované diagnóza prevence a kontrola MeSH
- imunosupresiva aplikace a dávkování škodlivé účinky MeSH
- krevní tlak účinky léků MeSH
- kyselina mykofenolová aplikace a dávkování škodlivé účinky MeSH
- ledviny imunologie patofyziologie MeSH
- lidé MeSH
- methylprednisolon MeSH
- mladiství MeSH
- nenasazení léčby * MeSH
- prospektivní studie MeSH
- rejekce štěpu imunologie patofyziologie prevence a kontrola MeSH
- transplantace ledvin škodlivé účinky MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- cyklosporin MeSH
- glukokortikoidy MeSH
- imunosupresiva MeSH
- kyselina mykofenolová MeSH
- methylprednisolon MeSH
BACKGROUND: Variable effects of steroid minimization strategies on blood pressure in pediatric renal transplant recipients have been reported, but data on the effect of steroid withdrawal on ambulatory blood pressure and circadian blood pressure rhythm have not been published so far. METHODS: In a prospective, randomized, multicenter study on steroid withdrawal in pediatric renal transplant recipients (n = 42) on cyclosporine, mycophenolate mofetil, and methylprednisolone, we performed a substudy in 28 patients, aged 11.2 ± 3.8 years, for whom ambulatory blood pressure monitoring (ABPM) data were available. RESULTS: In the steroid-withdrawal group, the percentage of patients with arterial hypertension, defined as systolic and/or diastolic blood pressure values recorded by ABPM > 1.64 SDS and/or antihypertensive medication, at month 15 was significantly lower (35.7%, p = 0.002) than in controls (92.9%). The need of antihypertensive medication dropped significantly by 61.2% (p < 0.000 vs. control), while in controls, it even rose by 69.3%. One year after steroid withdrawal, no patient exhibited hypertensive blood pressure values above the 95th percentile, compared to 35.7% at baseline (p = 0.014) and to 14.3% of control (p = 0.142). The beneficial impact of steroid withdrawal was especially pronounced for nocturnal blood pressure, leading to a recovered circadian rhythm in 71.4% of patients vs. 14.3% at baseline (p = 0.002), while the percentage of controls with an abnormal circadian rhythm (35.7%) did not change. CONCLUSIONS: Steroid withdrawal in pediatric renal transplant recipients with well-preserved allograft function is associated with less arterial hypertension recorded by ABPM and recovery of circadian blood pressure rhythm by restoration of nocturnal blood pressure dipping.
Division of Pediatric Nephrology Children's Hospital Memmingen Germany
Division of Pediatric Nephrology University Children's Hospital Jena Germany
Division of Pediatric Nephrology University Children's Hospital Marburg Germany
Hanover Medical School Carl Neuberg Str 1 30625 Hanover Germany
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