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Steroid withdrawal improves blood pressure control and nocturnal dipping in pediatric renal transplant recipients: analysis of a prospective, randomized, controlled trial

Höcker, Britta
Author Höcker, Britta ORCID Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. britta.hoecker@med.uni-heidelberg.de
Weber, Lutz T
Author Weber, Lutz T Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital, Cologne, Cologne, Germany
John, Ulrike
Author John, Ulrike Division of Pediatric Nephrology, University Children's Hospital, Jena, Germany
Drube, Jens
Author Drube, Jens Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
Fehrenbach, Henry
Author Fehrenbach, Henry Division of Pediatric Nephrology, Children's Hospital, Memmingen, Germany
Klaus, Günter
Author Klaus, Günter Division of Pediatric Nephrology, University Children's Hospital, Marburg, Germany
Pohl, Martin
Author Pohl, Martin Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Seeman, Tomáš
Author Seeman, Tomáš Department of Pediatrics, Second School of Medicine and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
Fichtner, Alexander
Author Fichtner, Alexander Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
Wühl, Elke
Author Wühl, Elke Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
Tönshoff, Burkhard
Author Tönshoff, Burkhard Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany

Pediatric nephrology (Berlin, Germany). 2019 Feb ; 34 (2) : 341-348. [epub] 20180904

Pediatr Nephrol
ISSN 1432-198X | 0931-041X
Source

Language English Country Germany Media print-electronic

Document type Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't

Persistent link https://www.medvik.cz/link/pmid30178240

PubMed 30178240
DOI 10.1007/s00467-018-4069-1
PII: 10.1007/s00467-018-4069-1
Knihovny.cz E-resources

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.

Department of General Pediatrics Adolescent Medicine and Neonatology Medical Center University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany

Department of Pediatrics 1 University Children's Hospital Im Neuenheimer Feld 430 69120 Heidelberg Germany

Department of Pediatrics 2nd School of Medicine and Biomedical Center Faculty of Medicine in Pilsen Charles University Prague Czech Republic

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

Pediatric Nephrology Children's and Adolescents' Hospital University Hospital Cologne Cologne Germany

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Pediatr Transplant. 2010 Dec;14(8):961-7 PubMed

Hypertension. 2002 Dec;40(6):795-6 PubMed