Association between systolic blood pressure and arterial stiffness in adolescent kidney transplant recipients: a single-center cross-sectional study

Background: Obesity, hyperlipidemia, intensive immunosuppressive use, and hypertension have detrimental effects on vascular structure and function after renal replacement therapy. Pulse wave velocity (PWV) is the gold standard for evaluating arterial stiffness. We aimed to determine cardiovascular target organ damage in adolescent kidney transplant patients using noninvasive PWV measurements and to investigate the risk factors that influence it. Methods: T his study included 4 5 adolescent patients who had u ndergone renal replacement therapy between 1994 and 2020 at Ege University Children's Hospital. Cardiovascular evaluation included PWV and augmentation index (AIx@75) measurements, expressed as Z-scores adjusted for sex and height. Biochemical, demographic, and clinical data were compared with height-adjusted PWV Z-scores (PWV Z-height) and AIx@75. Results: Twenty-four male and 21 female patients underwent transplantation at a mean age of 7.69±4.77 years. Systolic blood pressure (BP) Z-scores correlated significantly with PWV Z-height (ρ=0.56, P=0.001) and AIx@75 (ρ=0.29, P=0.049). Weak positive correlations were detected between PWV Z-height and triglyceride levels (ρ=0.45, P=0.02), mean arterial pressure (ρ=0.44, P=0.02), and C-reactive protein (ρ=0.42, P=0.04). Patients with higher AIx@75 (≥30) had significantly higher systolic BP Z-scores and PWV Z-height scores. Arterial stiffness indices did not differ by pretransplant dialysis modality. On multivariable linear regression, systolic BP Z-score was the only independent predictor of PWV Z-height (β=0.854, P<0.001). Conclusions: Posttransplant treatment of hypertension and hyperlipidemia is important to reduce cardiovascular burden in pediatric kidney transplant patients, highlighting the need for close monitoring and management of BP and lipid levels.