Influence of renal transplantation and living kidney donation on large artery stiffness and peripheral vascular resistance.

BACKGROUND Vascular status following renal transplantation (RT) may improve while living kidney donation (LKD) is possibly associated with an increased cardiovascular risk. METHODS We prospectively assessed glomerular filtration rate (mGFR, (51)Chrome EDTA clearance) and intermediate vascular risk factors in terms of blood pressure (BP), pulse wave velocity (PWV), central augmentation index (Alx), excess pressure (P-excess), and forearm vascular resistance in donors (n = 58, 45 +/- 13 years) and recipients (n = 51, 50 +/- 12 years) before and one year following LKD or RT. RESULTS After kidney donation, mGFR decreased by 33% to 65 +/- 11 ml/min/1.73m(2), while recipients obtained a mGFR of 55 +/- 9 ml/min/1.73m.(2) Ambulatory 24-hour mean arterial BP (MAP) remained unchanged in donors but decreased by 5 mm Hg in recipients (P < 0.05). Carotid-femoral PWV increased by 0.3 m/s in donors (P < 0.05) but remained unchanged in recipients. Alx was unaltered after LKD but decreased following RT (P < 0.01), and P-excess did not change in either group. Resting forearm resistance (R-test), measured by venous occlusion plethysmography, increased after LKD (P < 0.05) but was unaffected by RT, while no changes were seen in minimum resistance (R-min). Delta PWV showed a positive linear association to Delta 24-hour MAP in both groups. Multiple linear regression analysis (adjusting for age, gender, and the baseline value of the studied parameter) did not detect independent effects of graft function on 24-hour MAP, PWV, Alx, vascular resistance, or P-excess w whereas low post-donation GFR was related to higher Aix and R-rest. CONCLUSIONS RT reduced BP and Aix without affecting PWV, whereas LKD resulted in increased PWV and R-rest, despite unchanged BP.