P1714INTRA-ABDOMINAL PRESSURE IS ASSOCIATED WITH HIGHER RENAL RESISTIVE INDEX AFTER RENAL TRANSPLANTATION

• Published in: Nephrology, dialysis, transplantation Vol. 35; no. Supplement_3
• Main Authors: Coca, Armando, Gonzalez, Pablo, Arias-Cabrales, Carlos, Perez-Saez, Maria Jose, Rollan, Maria Jesus, Acosta-Ochoa, Isabel, Bustamante-Munguira, Elena, Mendiluce, Alicia, Pascual, Julio, Bustamante-Munguira, Juan
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-06-2020
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfaa142.P1714

Abstract
Background and Aims
The renal arterial resistive index (RRI) reflects renal hemodynamics non-invasively using Doppler arterial waveforms. RRI is defined by factors such as age, sex, weight, height or mean arterial pressure. Intra-abdominal hypertension (IAH) is a common complication among post-surgical patients that can affect renal blood flow. We aimed to determine the relationship between intra-abdominal pressure (IAP) and RRI in a sample of incident kidney transplant patients (KTs).
Method
Single-center prospective cohort of deceased-donor KTs. Anesthesia, surgical technique and immunosuppression induction therapy was the same in all cases. IAP monitoring was performed according to WSACS guidelines using the urinary bladder technique (UnoMeter Abdo-Pressure kit). IAP values were registered every 8h during the first 72h after surgery or until reoperation. Mean IAP values during the first 24h (24h-IAP) were used in this analysis. Doppler ultrasonography was performed 24h after surgery. RRI was calculated using the following formula: (peak systolic velocity – end-diastolic velocity)/peak systolic velocity. The study was approved by the local ethics committee and written informed consent was obtained in all cases.
Results
137 patients were enrolled. Table 1 summarizes relevant patient and hemodynamic variables. Stepwise multivariate linear regression analysis was used to examine independent predictors of RRI in this sample, including all variables in Table 1. Age (β=0.005, std.error=0.001, P<0.001), dialysis vintage (β=0.001, std.error<0.001, P=0.02) and 24h-IAP (β=0.005, std.error=0.003, P=0.041) were independent predictors of RRI.
Conclusion
Increased IAP in the first 24h after surgery is common in KTs and is correlated with higher RRI, which is associated with increased risk of graft loss and death.
All
No IAH
IAH
P
N
137
61
76
Age (years)
62 (52-69)
63 (51-73)
62 (53-69)
0,719
Male sex, n(%)
91 (66)
30 (49,2)
61 (80,3)
<0,001
Weight (kg)
71±13
64,9±11,5
75,5±12,7
<0,001
Height (cm)
165±9
162,9±9,1
167,3±8,5
0,004
Dialysis vintage (months)
19 (10-34)
15 (10-31)
23 (10-37)
0,248
HTN, n(%)
124 (91)
55 (90,2)
69 (90,8)
0,901
Diabetes, n(%)
23 (17)
11 (18)
12 (15,8
0,727
MAP (mmHg)
93 (90-98)
93 (90-98)
93 (90-98)
0,721
24h-IAP (mmHg)
12,4±3,5
9,3±1,7
14,9±2,4
<0,001
RRI
0,77 (0,7-0,83)
0,76 (0,7-0,82)
0,79 (0,73-0,88)
0,031
HTN, hypertension. IAH, intra-abdominal hypertension. IAP, intra-abdominal pressure. MAP, mean arterial pressure. RRI, renal resistive index.