DOI: 10.1161/circ.148.suppl_1.16656 ISSN: 0009-7322

Abstract 16656: Association of Mean Arterial Pressure Variability With Kidney Function in Living Kidney Donors

Ekamol Tantisattamo, Voramol Rochanaroon, Wanprapit Noree, Narisara Tribuddharat, Nisha Wanichwecharungruang, Narathorn Kulthamrongsri, Thanathip Suenghataiphorn, Piengpitch Naunsilp, Thitiphan Srikulmontri, Urairat Chuenchaem, Chanokporn Puchongmart, Ben Thiravetyan, Possawat Vutthikraivit, Manasawee Tanariyakul, Thiratest Leesutipornchai, Pakin Lalitnithi, Phuuwadith Wattanachayakul
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: While mean arterial pressure (MAP) is associated with poor kidney function, the association of MAP variability with kidney function in living kidney donors (LKD) is unknown. We aim to evaluate the association between MAP variability and kidney function post-donation.

Hypothesis: Wide MAP variability is associated with worsening kidney function post-donation.

Methods: A retrospective cohort study utilizing OPTN/SRTR included adult LKD undergoing donation between 6/1972 and 9/2022. MAP variability is assessed by the average real variability of MAP (ARV-MAP) defined byan average of absolute difference in consecutive MAP at 6, 12, and 24 months post-donation. The risk of ≥35% decrease in post-donation eGFR from pre-donation eGFR among quartiles (Q) for AVR-MAP was examined by multivariable Cox regression.

Results: Of 136,984 LKD, mean±SD age was 42±12 years and 61% were female. Mean pre-donation SBP, DBP, and MAP were 122±13, 74±9, and 90±10 mmHg, respectively. Mean post-donation BP at 6, 12, and 24 months were 120±13 / 75±9, 120±13 / 75±9, and 120±12 / 75±9 mmHg, respectively and corresponding mean post-donation MAP were 89.7±9.1, 89.8±9.0, and 90.2±9.0, respectively. Median (IQR) ARV-MAP was 6 (3, 10) mmHg. Mean pre-donation eGFR was 102.1±29.1 ml/min/1.73 m 2 and eGFR at 6-, 12-, and 24-months post-donation were 60.7±42.6, 62.4±43.9, and 64.4±44.9 ml/min/1.73 m 2 , respectively. The incidence rate of the event was 8.21 per 100 person-months. Compared to Q1 of the ARV-MAP, only Q3 had a 3.8% higher risk for declined eGFR (HR Q3 (95%CI) 1.04 (1.00, 1.08)). After adjusting for age, gender, race/ethnicity, U.S. citizenship status, level of education, history of hypertension, pre-donation BMI, pre-donation MAP, eGFR, and post-donation proteinuria, Q2, Q3, and Q4 have a 6.3%, 8.3%, and 6.9% significantly greater risk of the event, respectively (HR Q2 1.06 (1.00, 1.12); HR Q3 1.08 (1.02, 1.14); HR Q4 1.07 (1.01, 1.13)). There is no effect modification of the covariates for the ARV-PP - post-donation eGFR association.

Conclusions: The risk for a 35% decline in post-donation kidney function is associated with ARV-MAP. DBP and PP may involve in kidney function after unilateral nephrectomy in LKD who develop post-donation glomerular hyperfiltration.

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