Clinical impact of blood pressure variability in kidney transplant patients: a systematic review and meta-analysis

Abstract

Background: The association between blood pressure (BP) dipping profiles and kidney function among chronic kidney disease (CKD) patients has been well established within the literature, but studies conducted on kidney transplant (KT) patients remain limited. Individual KT studies have small sample sizes and conflicting results. Meta-analysis overcomes these limitations by pooling data to increase statistical power and provide robust clinical guidance. This meta-analysis systematically assesses the impact of BP patterns on KT and CKD populations, aiming to highlight improved BP management strategies in these populations. Materials and methods: A comprehensive search was conducted up to September 9th, 2024, using multiple electronic databases. Results: The current study included 7 studies with a total of 788 patients. KT recipients showed a higher prevalence of non-dipper blood pressure profile than CKD patients. Also, those with a dipper profile had a significantly higher estimated glomerular filtration rate (eGFR) compared to non-dippers and reverse dippers, implying better graft function. No significant differences were observed in acute rejection risk, proteinuria, renal resistive index, cholesterol, or triglycerides across blood pressure profiles. Conclusions: These findings reveal a high prevalence of non-dipping blood pressure profiles in KT and CKD patients, linked to worse renal and cardiovascular outcomes, while also highlighting the need for ambulatory blood pressure monitoring and tailored BP management strategies in these high-risk populations to potentially improve outcomes. However, the observational nature of available studies limits causal inference, and further prospective research is required to establish definitive therapeutic recommendations.