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See detailUrinary and dietary sodium and potassium associated with blood pressure control in treated hypertensive kidney transplant recipients: an observational study
Saint-Remy, Annie ULg; SOMJA, Mélanie ULg; Gellner, Karen et al

in BMC Nephrology (2012), 13

Background In kidney transplant (Kt) recipients, hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory. Office BP ... [more ▼]

Background In kidney transplant (Kt) recipients, hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory. Office BP (OBP) remains frequently used for clinical decisions, however home BP (HBP) have brought a significant improvement in the BP control. Sodium is a modifiable risk factor, many studies accounted for a decrease of BP with a sodium restricted diet. Increased potassium intake has been also recommended in hypertension management. Using an agreement between office and home BP, the present study investigated the relations between the BP control in Kt recipients and their urinary excretion and dietary consumption of sodium and potassium. Methods The BP control defined by OBP <140/90 mmHg and HBP <135/85 mmHg was tested in 70 Kt recipients (mean age 56 +/- 11.5 years; mean graft survival 7 +/- 6.6 years) treated with antihypertensive medications. OBP and HBP were measured with a validated oscillometric device (Omron M6(R)). The 24-hour urinary sodium (Na+) and potassium (K+) excretions as well as dietary intakes were compared between controlled and uncontrolled (in office and at home) recipients. Non parametric Wilcoxon Mann--Whitney Test was used for between groups comparisons and Fisher's exact test for frequencies comparisons. Pearson correlation coefficients and paired t-test were used when sample size was >30. Results Using an agreement between OBP and HBP, we identified controlled (21%) and uncontrolled recipients (49%). Major confounding effects susceptible to interfere with the BP regulation did not differ between groups, the amounts of sodium excretion were similar (154 +/- 93 vs 162 +/- 88 mmol/24 h) but uncontrolled patients excreted less potassium (68 +/- 14 vs 54 +/- 20 mmol/24 h; P = 0.029) and had significantly lower potassium intakes (3279 +/- 753 vs 2208 +/- 720 mg/24 h; P = 0.009), associated with a higher urinary Na+/K + ratio. Systolic HBP was inversely and significantly correlated to urinary potassium (r = -0.48; P = 0.002), a positive but non significant relation was observed with urinary sodium (r = 0,30;P = 0.074). Conclusions Half of the treated hypertensive Kt recipients remained uncontrolled in office and at home. Restoring a well-balanced sodium/potassium ratio intakes could be a non pharmacological opportunity to improve blood pressure control. [less ▲]

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See detailDietary and urinary excretion of sodium and potassium associated with blood pressure control in treated hypertensive kidney transplant patients
Saint-Remy, Annie ULg; SOMJA, Mélanie ULg; BONVOISIN, Catherine ULg et al

Conference (2012, April 26)

Abstract Background. In kidney transplant (kt) recipients , hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory ... [more ▼]

Abstract Background. In kidney transplant (kt) recipients , hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory. Office BP (OBP) remains the most frequently used for clinical decisions, however home BP (HBP) have brought a significant improvement in the BP control. Sodium is a modifiable risk factor, many studies accounted for a decrease of BP with a sodium restricted diet. Increased potassium intake has been also recommended in hypertension management. Using an agreement between office and home BP, the present study investigated the relations between the BP control in kt recipients and their urinary excretion and dietary consumption of sodium and potassium. Methods. The BP control defined by OBP <140/90 mmHg and HBP <135/85 mmHg was measured in 70 kt recipients (mean age 56 ± 11.5 years; mean graft survival 7 ± 6.6 years) treated with antihypertensive medications. OBP and HBP were measured with a validated oscillometric device (Omron M6â). 24-hour urinary sodium (Na+) and potassium (K+) excretion as well as dietary intakes (food recall) were compared between controlled and uncontrolled (in office and at home) recipients. Non parametric Wilcoxon Mann-Whitney Test was used for between groups comparisons and Fisher’s exact test for frequencies comparisons. Results. Using an agreement between OBP and HBP, we identified controlled (21%) and uncontrolled recipients (49%). Major confounding effects susceptible to interfere with the BP regulation did not differ between groups, the amounts of sodium excretion were similar (154 ± 93 vs 162 ± 88 mmol/24h) but uncontrolled patients excreted less potassium (68 ± 14 vs 54 ± 20 mmol/24h; P=0.029) and had significantly lower intakes (3279 ± 753 vs 2208 ± 720 mg/24h; P=0.009), resulting in a higher Na+/K+ ratio. Systolic HBP was inversely and significantly correlated to urinary potassium when age, BMI and urinary sodium were controlled (r= -0.46; P=0.002). When age, BMI and urinary potassium were controlled, a positive relation was observed with urinary sodium (P=0.042). Conclusions. Half of the treated hypertensive kt recipients remained uncontrolled in office and at home. Restoring a well-balanced sodium/potassium ratio intakes could be a non pharmacological opportunity to improve blood pressure control. [less ▲]

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See detailAssociation entre le contrôle de la pression artérielle et le rapport sodium/potassium urinaire chez les transplantés rénaux hypertendus
Saint-Remy, Annie ULg; SOMJA, Mélanie ULg; WEEKERS, Laurent ULg et al

Poster (2011, December 15)

Design and method : Office blood pressure (OBP) and home BP (HBP) were measured in 70 kidney transplant patients (KT) (43 men/27 women;KT>1 year), all were treated with antihypertensive drugs (mean number ... [more ▼]

Design and method : Office blood pressure (OBP) and home BP (HBP) were measured in 70 kidney transplant patients (KT) (43 men/27 women;KT>1 year), all were treated with antihypertensive drugs (mean number: 2±1). Mean age: 56±11 years, mean graft survival: 7±6.6 years, mean GFR: 65.6±24 ml/min, diabetes:27% and current smoking:11.5%. HBP (Omron M6) was measured during 7 days following the OBP measurement, mean HBP was calculated from day 2 to day 7. Uncontrolled BP was defined by OBP>=140-90 (>=130-80 when diabetes) and HBP>=135-85 (>=130-80 when diabetes). The day of the OBP measurement and the last day of HBP, patients collected 24h- urine and recorded at the same time their food and beverage consumption. Sodium and potassium were measured in urines and their intakes were quantified through food records. Urinary and diet Na+, K+ did not differ between the two urine collections 7 days apart. Results: 16 patients(23%) had controlled BP (OBP and HBP) while 34 (49%) remained with sustained hypertension (SHT) despite treatment, 14 (20%) had masked uncontrolled hypertension (MHT, OBP<140-90 and HBP>=135-85,130-80 if diabetes for both).When comparing the controlled and SHT, no differences were found with age, graft survival, BMI, GFR, calcineurin inhibitors or number and type of antihypertensive drugs. The groups did not differ by their sodium excretion (154±93 vs 162±88 mmol/24h) but well by their K excretion significantly higher in controlled patients (68±17 vs 53±20 mmol/24h,p=0.018) giving a Na/K ratio higher in SHT (3.2±1.3 vs2.2±1.2,p=0.03). Diet analysis showed significantly higher intakes of K (fruits, vegetables) in controlled patients (3279±753 vs 2208±720 mg/24h,p=0.010) whereas both groups consumed on average 9 g/24h of salt. When controlled for age, BMI and Na excretion, Home systolic BP was inversely and significantly correlated with urinary potassium (- 0.46;P=0.002) while no correlation was found with urinary Na.Conclusions: KT patients remaining hypertensive and well controlled patients had both high salt consumption. However, well controlled patients differed by significant higher potassium intakes and excretion. Urinary Na/K ratio could be a useful tool contributing to an optimal BP control in KT patients. However, impact of increasing potassium intakes on uncontrolled BP in KT has to be validated by prospective randomized studies [less ▲]

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See detailAssociation entre le contrôle de la pression artérielle et le rapport sodium/potassium urinaire chez les transplantés rénaux hypertendus
Saint-Remy, Annie ULg; SOMJA, Mélanie ULg; WEEKERS, Laurent ULg et al

in Archives des Maladies du Coeur et des Vaisseaux (2011, December), Hors série 3

Etude de la relation entre le contrôle de la pression artérielle (PA) mesurée en clinique et/ou à domicile chez des transplantés rénaux (Tr) hypertendus et l'excrétion urinaire du sodium (Na), potassium ... [more ▼]

Etude de la relation entre le contrôle de la pression artérielle (PA) mesurée en clinique et/ou à domicile chez des transplantés rénaux (Tr) hypertendus et l'excrétion urinaire du sodium (Na), potassium (K) et de leur rapport (Na/K urinaire et alimentaire) qui pourrait être un indice utile à prendre en compte dans la recherche d'un contrôle efficace de la PA chez les transplantés rénaux. [less ▲]

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