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ISSN 0016-3813 (Impreso)

2005, Número 6

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Gac Med Mex 2005; 141 (6)


Hipertensión arterial postrasplante renal: factores de riesgo asociados e influencia en la supervivencia del injerto renal

Chew-Wong A, Alberú-Gómez J, Abasta-Jiménez M, Márquez-Díaz F, Correa-Rotter R

Idioma: Español
Referencias bibliográficas: 50
Paginas: 461-468
Archivo PDF: 67.06 Kb.


RESUMEN

La hipertensión arterial postrasplante renal (HAPT) se ha asociado con una disminución de la supervivencia del injerto renal y aumento de la morbilidad y mortalidad de los receptores de trasplante. La prevalencia de la HAPT es de 50% y con el uso de inhibidores de calcineurina se ha incrementado a 60-80%. Con el objeto de conocer la frecuencia de la HAPT en la población de pacientes del Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, los factores de riesgo asociados a su desarrollo y el efecto de ésta en la supervivencia del injerto renal a largo plazo, se analizaron retrospec-tivamente los expedientes de los pacientes sometidos a trasplante renal de 1984 a 1994. Los factores de riesgo analizados fueron: edad, género, causa de insuficiencia renal, hipertensión arterial pretras-plante, histocompatibilidad, presencia de episodios de rechazo agudo, presencia de rechazo crónico, creatinina sérica (CrS) y uso de Ciclospo-rina A. Se dividió a la población en dos grupos: normotensos (NT) e hipertensos (HT). Se definió HAPT como presión arterial (PA) 3 140/90 mmHg por lo menos en dos visitas consecutivas o la utilización de tratamiento antihipertensivo. Se analizaron 215 seguimientos en 205 pacientes (10 pacientes con dos trasplantes), con edad al momento del trasplante de 30 ±: 9 años y género masculino/femenino 131/84. Cursaron con hipertensión arterial pretrasplante 188 (88%). El seguimiento postrasplante promedio fue de 56 ± 32 meses. En el período postrasplante se encontraron 152 HT (71%) y 63 (29%) NT. El grupo HT mostró una PA y CrS mayores que el grupo de NT (P ‹0.001) a pesar de contarse con un control antihipertensivo adecuado en 65% de los casos de HT. El grupo de NT tuvo mayor supervivencia del injerto que el grupo de HT, 60 ± 30 meses vs 51 ± 32 meses (p &~139;0.01). El análisis multivariado de los diversos factores de riesgo estudiados no mostró alguna asociación independiente con el desarrollo de HAPT. La prevalencia de la HAPT en nuestro estudio es similar a lo informado en la literatura. En la etapa postrasplante disminuyó el porcentaje de pacientes hipertensos (88% pre vs 71% postrasplante). La presencia de HAPT constituye un factor de mal pronóstico para la supervivencia del injerto a largo plazo.


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