Comparison of anxious and depressive symptomatology among pretransplant hepatic patients and their relatives

Objective

We sought to compare the anxiety and depressive symptoms of patients undergoing pretransplant evaluation with those of their closest relatives.

Materials and Methods

We assessed 51 patients with hepatic cirrhosis and 51 relatives who were the main care giver for each patient. All subjects were assessed during the interval when the patients were hospitalized to undergo the medical assessment to determine their inclusion on the waiting list for liver transplantation. In both groups, we used a “Psychosocial Survey” and the “Hospital Anxiety and Depression Scale.”

Results

Significant differences were observed in anxiety (P = .001), but not in depression (P = .820). Specifically, relatives presented higher levels of anxiety compared with the hepatic patients.

Conclusion

The relatives were worse off psychologically than the patients.     

Influence of Single-Nucleotide Polymorphisms on C-Reactive Protein Levels in Chronic Kidney Disease Before and After Kidney Transplantation

Introduction

We sought to evaluate 2 single-nucleotide polymorphisms (SNPs) in the C-reactive protein (CRP) gene promoter region for their effects on CRP levels in chronic kidney disease (CKD) patients before and after a successful kidney transplantation.

Methods

Fifty CKD patients were evaluated before and at the first and second years after the graft. Two SNPs were studied, a bi-allelic (G→A) at the −409 and a tri-allelic (C→T→A) variation at the −390 position in the CRP gene.

Results

All patients presented the −409GG genotype. At the −390 position, the “A” allele was not found; there were 15 “CC” patients, 11 “TT” patients, and 24 “CT” patients. CRP levels were different among patients with various genotypes (P < .019). Also the presence of the allele “T” was sufficient to determine differences in CRP levels both in pretransplantation (P = .045) and at 1 year posttransplantation (P = .011), but not at the second year (P = .448).

Conclusion

SNPs at the −390 position of the CRP gene promoter region influence CRP basal levels in such a way that the “C” allele correlated with the lowest and the “T” with the highest. We did not observe this influence in our patients at the second year posttransplantation.     

The timing of delivery of infants with gastroschisis influences outcome

Background

The delayed onset of intestinal function in children with gastroschisis may be because of the injurious effects of amniotic fluid on the exposed bowel. This has led to consideration of early delivery to minimize intestinal damage and improve outcome, although this has not been carefully evaluated. The authors hypothesized that timing of delivery influences outcome in children with gastroschisis, and sought to evaluate the relative impact of factors that predict outcome in this disease.

Methods

All consecutive patients with gastroschisis (1992-2002) were divided into those delivered before (“early”) or after (“late”) 36 weeks. Bowel peel was described as “thin” or “thick,” based on operative reports. Individual measures were analyzed by univariate analyses (χ²/Student's t test), and logistic regression was used to identify significant factors for the length of stay (LOS) longer than the population average of 55 days.

Results

In 75 patients, 53.4% were “early” and 46.6% were “late.” Groups were similar with respect to maternal age, birth weight, delivery mode, sex, and associated anomalies. Thickness of bowel peel was not affected by delivery time, yet “early” patients had significantly longer LOS and time to enteral feeds. Significant predictors of LOS more than 55 days included gestational age of 36 weeks or younger, time to enteral feeds of more than 26 days, and associated anomalies. Nonsignificant predictors included size of the defect, thickness of bowel peel, and need for silo.

Conclusions

Delivery before 36 weeks is associated with longer hospitalization and increased tune to attainment of full feeds compared with later delivery. Fetal well-being should thus be the primary determinant of delivery for gastroschisis, as opposed to considerations regarding possible injurious effects to the bowel of prolonged gestation.     

Surgery improves quality of life in patients with “mild” hyperparathyroidism

Background

Surgical treatment of patients with “classic” hyperparathyroidism improves quality of life, but these benefits to patients with “mild” disease remain unclear.

Methods

The SF-36 Health Survey was administered to 174 patients 1 week before, 1 week after, and 1 year after undergoing parathyroidectomy.

Results

One hundred fifty-one patients completed at least 2 surveys. There were 18 and 133 cases of “mild” and “classic” hyperparathyroidism, respectively. Preoperatively, the groups did not differ significantly in the 10 scales. One year after surgery, patients with “classic” and “mild” disease improved significantly in 9/10 and 10/10 scales, respectively (P < 0.05). Those with “mild” disease had a statistically larger improvement than those with “classic” disease in 4 scales.

Conclusions

Quality of life significantly improved in surgically treated patients with both “mild” and “classic” hyperparathyroidism, supporting surgical treatment of “mild” hyperparathyroidism. Moreover, quality of life may improve more in patients with “mild” rather than “classic” disease.     

Obsessive-compulsive psychological symptoms of patients on the liver transplant waiting list

Introduction

Patients on the liver transplant waiting list have increased emotional and clinical symptoms. The presence of psychopathologic symptoms associated with obsession-compulsion as a reflection of alterations due to anxiety disorders is common in these patients.

Objective

To evaluate obsessive-compulsive psychopathological symptoms in patients on the liver transplant waiting list.

Materials and methods

The study included 50 patients on the liver transplant waiting list. The instrument was the SA-45 questionnaire (Derogatis, 75), whose Spanish version was adapted by González Rivera and De las Cuevas (1988). This dimension was evaluated using five statements.

Results

Among of the patients on the liver transplant waiting list, 46% had no relevant obsessive-compulsive symptoms. Of these, 28% had no symptoms and 18% had some symptoms, but the overall evaluation in these patients was no greater than the cutoff point. The remaining 54% had relevant obsessive-compulsive clinical symptoms, most commonly (1) “Having difficulty making decisions” (P < 3.45 · 10⁻⁹); (2) “Having difficulty concentrating” (P < 1.70 · 10⁻⁸); (3) “One's mind goes blank” (P < 3.04 · 10⁻⁴); (4) “Having to repeatedly check everything being done” (P < 1.37 · 10⁻¹); and (5) “Having to do things slowly to make sure they are done properly” (P < 5.02 · 10⁻¹).

Conclusions

Many patients on the liver transplant waiting list have obsessive-compulsive psychopathologic symptoms. Their detection and application of adequate psychological treatment are important to minimize the effects of emotional changes onward from the pretransplant phase.     

Psychological Adaptation and Quality of Life of Adult Intestinal Transplant Recipients: University of Bologna Experience

Introduction

Intestinal transplantation has become an accepted therapy for individuals permanently dependent on total parenteral nutrition (TPN) with life-threatening complications. Quality of life and psychological well-being can be seen as important outcome measures of transplantation surgery.

Methods

We evaluated 24 adult intestinal transplant recipients and 24 healthy subjects (a control group). All subjects were administered the Italian Version of the Psychological Well-Being Scales (PWB) by C. Ryff, the World Health Organization Quality of Life-Brief (WHOQOL), and the Symptom Questionnaire (SQ) by R. Kellner and G.A. Fava, a symptomatology scale. Quality of life and psychological well-being were assessed in transplant recipients in relationship to the number of rejections, the number of admissions, and the immunosuppressive protocol.

Results

Intestinal transplant recipients reported significantly higher scores in the “personal growth” category (P = .036) and lower scores in the “positive relation with others” (P = .013) and “autonomy” (P = .007) dimensions of PWB, compared with the controls. In the WHOQOL, the scores of transplant recipients were lower only in the psychological domain (P = .011). Transplant recipients reported significantly higher scores in the “somatic symptom” (P = .027) and “hostility” (P = .018) dimensions of the SQ, compared with the controls. Transplant recipients with number of admissions >8 reported higher scores in “anxiety” (P = .019) and “depression” (P = .021) scales of the SQ, and the patients with a Daclizumab protocol reported higher scores in “depression” (P = .000) and “somatic symptom” (P = .008) of the SQ. There were no significant differences regarding number of rejections and socio-demographic variables.

Conclusion

Improvement of psychological well-being in the transplant population may be related to the achievement of the goal of transplantation: recovery of bowel function. But the data confirmed that the transplant experience required a long and difficult adaptation trial to the new condition of “transplant recipient.”     

Mechanism of bar displacement and corresponding bar fixation techniques in minimally invasive repair of pectus excavatum

Purpose

Bar displacement is a major complication in repair of pectus excavatum with the Nuss technique. Mechanisms of bar displacement have been elucidated by case-by-case analysis, and specific bar fixation techniques have been developed to deal with each mechanism. The efficacy of our bar fixation techniques is appraised.

Methods

Data from 725 consecutive patients between 1999 and 2006 who were repaired with our modifications to the Nuss procedure were retrospectively analyzed.

Results

The mechanism of bar displacement consisted of one or a combination of the following types: type 1, “bar flipping”—rotation of the bar along the axis of hinge; type 2, “lateral sliding”—horizontal slipping of the bar to one side in asymmetric pectus excavatum; and type 3, “hinge-point disruption”—a dorsal shift of the bar owing to tearing of the supporting intercostal musculature. Specific bar fixation techniques have been tailored to compensate for potential mechanisms of bar displacement according to pectus morphology: multipoint pericostal bar fixation (MPF) (n = 496) for type 1 displacement; incorporation of a stabilizer on the depressed side (n = 169) for type 2 displacement; and hinge point reinforcement and the crane technique (n = 122) for type 3 displacement. The bar displacement rate was decreased with our mechanism-based approach (4.6% before MPF vs 1.8% after MPF, P = .045). In addition, the major complication rates (6.8% before MPF vs 2.0% after MPF, P = .001) and reoperation rates (5.5% before MPF vs 1.6% after MPF, P = .019) decreased.

Conclusions

Mechanism-based bar fixation techniques, especially multipoint pericostal wire fixation, seems to be effective in preventing bar displacement following pectus excavatum repair.     

Factors influencing survival in newborns with congenital diaphragmatic hernia: the relative role of timing of surgery

Purpose

Controversy persists regarding the factors influencing survival in patients with congenital diaphragmatic hernia (CDH), in particular, the role of timing of surgery. The authors therefore sought to determine such factors and to assess the relative role of timing of surgery on outcome.

Methods

All CDH newborns 1991 through 2002 (n = 111) were divided into those undergoing repair before (“early” n = 35), or after (“late” n = 76) 48 hours. A multivariate analysis was performed to determine the relative impact of various factors on survival rate.

Results

Overall survival rate was 64%. There was no effect on survival of heart rate, temperature, systolic blood pressure, age, extracorporeal membrane oxygenation use, mesh use, infections, or intracranial hemorrhage, and there was no difference between early (68%) or late (62%) repair (P = .2). Initial pco₂ greater than 50, po₂ less than 40, cardiac defects, or renal failure significantly decreased survival rate.

Conclusions

Significant factors influencing survival rate in patients with CDH include cardiac defects, renal failure, and the initial blood gases and not the timing of surgery. CDH repair should be based on the optimization of clinical parameters as opposed to a specific time period to improve outcome.     

Coping styles of patients on the liver transplant waiting list

Introduction

Chronic end-stage liver disease is a difficult situation for the patient.

Objective

The objective of this study was to analyze the disease coping styles of patients on the liver transplant waiting list.

Materials and Methods

The study included 50 patients on the liver transplant waiting list. The instrument used was the Mental Adjustment to Cancer Scale (Ferrero, 94). Coping scales were as follows: fighting spirit, hopelessness, anxious preoccupation, fatalism, and negation.

Results

Only 6% of subjects adapted well, whereas 94% adapted badly: 89% poor fighting spirit, 32% hopelessness, 50% anxious preoccupation, 28% fatalism, and 30% negation. Of those who had a poor fighting spirit, 88% also used another type of maladaptive style. The associated statements were (P < .05) as follows: “I value my life more”; “I don't think about the disease”; “I think about people who are worse off.” Regarding hopelessness, 100% of those who confessed hopelessness also showed maladaptive signs. The associated statements were (P < .05) as follows: “I cannot cheer myself up”; “I cannot help myself”; “I've given up.” Regarding anxious preoccupation, nearly all of these patients (96%) provided dysfunctional answers. The most associated were (P < .05) as follows: “I don't have any plans”; “I feel a lot of anxiety”; “I'm very angry.” Regarding fatalism, all of the patients also had maladaptive behavior. The main types were (P < .05) as follows: “Nothing will change things”; “I cannot control the situation”; “I don't need information.” Regarding negation, Only 14% used this style, and in 86% negation was associated with other inadequate coping styles.

Conclusions

Patients on the liver transplant waiting list were maladaptive to their disease. It is important to establish adequate psychological care for these patients, given the important repercussions in the posttransplantation phase.     

Survival rate in congenital diaphragmatic hernia: the experience of the Canadian Neonatal Network

Background/purpose

The Canadian Neonatal Network prospectively collects data from 17 pediatric hospitals accounting for 75% of all neonatal intensive care unit beds nationwide. The purpose of this study was to (1) analyze the database to compare actual survival rates of neonates with congenital diaphragmatic hernia (CDH) to predicted outcomes and (2) assess whether institutional CDH volume was associated with improved survival rate.

Methods

Actual survival rates for CDH patients born during a 22-month period were determined from the registry. Predicted survival rates were calculated using the CDH Study Group logistical regression equation. Actual survival rate was compared with predicted using χ² analysis. Survival rates were stratified by institutional CDH volume and compared using binomial analysis. P value of less than .05 was deemed statistically significant.

Results

Of approximately 20,500 neonatal admissions, 88 cases of CDH were recorded. Seventy-three of 88 (83%) neonates with CDH survived to discharge, whereas the predicted survival rate was 62% (P < .001). Three centers were considered “high-volume” centers with at least 12 CDH diagnoses, and 11 were considered “low-volume” centers. Actual CDH survival was significantly greater at high-versus low-volume centers (90% v 77%; P < .01).

Conclusions

From these prospective data, survival rates of Canadian neonates with CDH are significantly better than predicted by the CDH Study Group equation. Further, high-volume centers in Canada have a significantly higher CDH survival rate than low-volume centers.     

Conflicts in wound classification of neonatal operations

Background/Purpose

This study sought to determine the reliability of wound classification guidelines when applied to neonatal operations.

Methods

This study is a cross-sectional web-based survey of pediatric surgeons. From a random sample of 22 neonatal operations, participants classified each operation as “clean,” “clean-contaminated,” “contaminated,” or “dirty or infected,” and specified duration of perioperative antibiotics as “none,” “single preoperative,” “24 hours,” or “>24 hours.” Unweighted κ score was calculated to estimate interrater reliability.

Results

Overall interrater reliability for wound classification was poor (κ = 0.30). The following operations were classified as clean: pyloromyotomy, resection of sequestration, resection of sacrococcygeal teratoma, oophorectomy, and immediate repair of omphalocele; as clean-contaminated: Ladd procedure, bowel resection for midgut volvulus and meconium peritonitis, fistula ligation of tracheoesophageal fistula, primary esophageal anastomosis of esophageal atresia, thoracic lobectomy, staged closure of gastroschisis, delayed repair and primary closure of omphalocele, perineal anoplasty and diverting colostomy for imperforate anus, anal pull-through for Hirschsprung disease, and colostomy closure; and as dirty: perforated necrotizing enterocolitis.

Conclusions

There is poor consensus on how neonatal operations are classified based on contamination. An improved classification system will provide more accurate risk assessment for development of surgical site infections and identify neonates who would benefit from antibiotic prophylaxis.     

A tale of two trainers: virtual reality versus a video trainer for acquisition of basic laparoscopic skills

Background

This study aimed to assess the transferability of basic laparoscopic skills between a virtual reality simulator (MIST-VR) and a video trainer box (D-Box).

Methods

Forty-six medical students were randomized into 2 groups, training on MIST-VR or D-Box. After training with one modality, a crossover assessment on the other was performed.

Results

When tested on MIST-VR, the MIST-VR group showed significantly shorter time (90.3 seconds vs 188.6 seconds, P <.001), better economy of movements (4.40 vs 7.50, P <.001), and lower score (224.7 vs 527.0, P <.001). However, when assessed on the D-Box, there was no difference between the groups for time (402.0 seconds vs 325.6 seconds, P = .152), total hand movements (THC) (289 vs 262, P = .792), or total path length (TPL) (34.9 m vs 34.6 m, P = .388).

Conclusion

Both simulators provide significant improvement in performance. Our results indicate that skills learned on the MIST-VR are transferable to the D-Box, but the opposite cannot be demonstrated.     

Incisional hernia repair by fascial component separation: results in 128 cases and evolution of technique

Background

Most ventral incisional hernias are repaired using 1 of 2 principal techniques: (1) prosthetic repair (open or laparoscopic) and (2) primary reconstruction by fascial component separation. Primary midline restoration provides physiological advantages, and avoidance of mesh may reduce complications. This report describes 128 cases of incisional hernia repair by fascial release. Evolution of the technique produced modifications and fewer complications.

Methods

Fascial component separation was performed either by “classic” technique (broad skin flaps) in group 1 and by “perforator preservation” (fascial release through separate inferolateral incisions) in group 2.

Results

Mortality was .75% (1/128). Major complications occurred in 7 patients (5.5%). Total recurrence rate is 16% (21/128) with major recurrences in 9.3% (12/128). Both groups were statistically equivalent in demographics, comorbidities, and recurrences. Group 1 had significantly higher rates of skin necrosis (P < .001) and chronic pain (P = .003).

Conclusions

Fascial component separation can provide satisfactory results in uncomplicated incisional hernias, but skin necrosis is prohibitive without perforator preservation.     

Psychosocial Determinants of Quality of Life 6 Months After Transplantation: Longitudinal Prospective Study

Objectives

We sought to investigate the psychosocial determinants of quality of life at 6 months after transplantation.

Methods

A sample of liver transplant candidates (n = 60), composed of consecutive patients (25% with familial amyloid polyneuropathy [FAP]) attending outpatient clinics was assessed in the pretransplant period using the Neo Five Factor Inventory, Hospital Anxiety and depression Scale (HADS), Brief COPE, and SF-36, a quality-of-life, self-rating questionnaire. Six months after transplantation, these patients were assessed by means of the SF-36.

Results

Psychosocial predictors where found by means of multiple regression analysis. The physical component of quality of life at 6 months after transplantation was determined based upon coping strategies and physical quality of life in the pretransplant period (this model explained 32% of variance). The mental component at 6 months after transplantation was determined by depression in the pretransplant period and by clinical diagnoses of patients. Because FAP patients show a lower mental component of quality of life, this diagnosis explained 25% of the variance.

Conclusions

Our findings suggested that coping strategies and depression measured in the pretransplant period are important determinants of quality of life at 6 months after liver transplantation.     

Laparoscopic vs percutaneous endoscopic gastrostomy tube insertion: a new pediatric gold standard?

Background/Purpose

Gastrostomy tube insertion is frequently performed in children. Percutaneous endoscopic gastrostomy (PEG) insertion, considered by many to be the “gold standard,” is unavoidably associated with a risk of intestinal perforation and frequently requires a second anesthetic for its replacement with a low-profile “button.” We hypothesized that a laparoscopic technique with low-pressure insufflation would yield comparable outcomes, a lower procedural complication rate, and require fewer anesthetics per patient.

Methods

A retrospective review of all surgeon-placed gastrostomy tubes (exclusive of those associated with fundoplication or other procedures) between January 2002 and December 2003 was undertaken. Data collected included type of procedure (PEG vs laparoscopic), indication, patient demographics (including neurologic comorbidity), operative time, complications (procedure-specific and nonspecific), and number of procedural anesthetics to “achieve” a low-profile tube. Groups were compared by univariate and multiple logistic regression analyses.

Results

One hundred nineteen gastrostomy tubes (26 laparoscopic = 21.8%) were inserted. The PEG and laparoscopic gastrostomy groups were comparable from the perspectives of age, size, indications for tube placement, and operative time. The complication rate after PEG placement was significantly higher than after LG (14% vs 7.7%; P = .023), and 72 (77.4%) of PEG patients required a second anesthetic for tube change.

Conclusions

Laparoscopic gastrostomy tube insertion is safe and easy to perform, with outcomes comparable to that of PEG tube insertion. It obviates the need for a second procedural anesthetic and may emerge as the gold standard for gastrostomy tube placement.     

A prospective study of the clinical impact of a multidisciplinary head and neck tumor board

Objective

There have been no studies undertaken on the effect of the multidisciplinary head and neck tumor board on treatment planning. The objective of this study was to determine the efficacy of the multidisciplinary tumor board in altering diagnosis, stage, and treatment plan in patients with head and neck tumors.

Study Design

Case series with planned data collection.

Setting

Comprehensive cancer center and tertiary academic hospital.

Subjects and Methods

A prospective study of the discussions concerning 120 consecutive patients presented at a multidisciplinary head and neck tumor board was performed. As each patient was presented, a record was made of the “pre-conference” diagnosis, stage, and treatment plan. After case discussion, the “post-conference” diagnosis, stage, and treatment plan were recorded. Results are compared between malignant and benign tumor cohorts.

Results

The study population comprised 120 patients with new presentations of head and neck tumors: 84 malignancies and 36 benign tumors. Approximately 27 percent of patients had some change in tumor diagnosis, stage, or treatment plan. Change in treatment was significantly more common in cases of malignancy, occurring in 24 percent of patients versus six percent of benign tumors (P = 0.0199). Changes in treatment were also noted to be largely escalations in management (P = 0.0084), adding multi-modality care.

Conclusion

A multidisciplinary tumor board affects diagnostic and treatment decisions in a significant number of patients with newly diagnosed head and neck tumors. The multidisciplinary approach to patient care may be particularly effective in managing malignant tumors, in which treatment plans are most frequently altered.     

Increasing the Participation of Intensive Care Unit Nurses to Promote Deceased Donor Organ Donation

Introduction

Intensive care unit (ICU) nurses are viewed to have an important role in identifying potential donors to increase the donor pool. Our objectives were to assess their knowledge about organ donation, their attitudes concerning their presumed role in organ donation, and their motivation toward a more prominent role by 3 questionnaires administered before and after training on promotion of organ donation.

Methods

Twelve nurses from 3 different ICU departments were selected to participate in a prospective evaluation. Their perceptions and attitudes on organ donation were assessed by means of 3 questionnaire forms that focused on “knowledge of organ donation,” “attitudes toward endorsement of organ donation,” and “motivation in promoting organ donation.” Two video-illustrated lectures were given. A re-evaluation using the same 3 questionnaire forms was done to analyze the effect of training on their knowledge, attitude, and motivation.

Results

A marked gain in knowledge (P < .001), change in attitude (P < .001), and increase in motivation (P < .001) were seen after training. Nurses understood the need to promote organ donation and the crucial role of nurses in early detection of possible deceased organ donors. They agreed to encourage the patients' relatives consent to donation of their beloved one's organs.

Conclusion

Active participation of ICU nurses in the identification of potential deceased donor organs and their direct participation in organ procurement though continuous re-education and video- illustrated lectures may promote an increased number of deceased donor organs.     

Upper cervical spine injuries: indications and limits of the conservative management in Halo vest. A systematic review of efficacy and safety

Introduction

The integrity of the upper cervical spine is essential for survival and function, because of the neurovascular structures contained within its bony elements. Fractures of the upper cervical spine (C1-C2) are frequent. This systematic review assesses the efficacy and safety of the conservative management in Halo vest for patients with upper cervical spine fractures.

Materials and methods

Two reviewers independently identified studies in English, by a systematic search of CINAHL, Embase, Medline, HealthSTAR, and the Cochrane Central Registry of Controlled Trials, from inception of each database to 28 January 2010, using various combinations of the keywords terms “odontoid fractures”, hangman's fractures”, “axis fractures”, “axis”, “atlas”, “Jefferson fractures”, “C1 arch fractures”, “C1 fractures”, “C2 fractures”, “cervical spine”, “injuries”, “fracture”, “trauma”, “neck injury”, “surgery”.

Results

A total of 43 citations were obtained. An additional 4 papers were obtained from the reference list of the studies included. The 47 studies that were included described a total of 1078 patients with C1-C2 fractures managed by halo fixator.

Conclusions

The halo fixator has a well defined place in the management of fractures of the cervical spine. Clearly, studies of higher level of evidence, for instance large randomised trials, should be conducted, even though the available evidences suggest that management of upper cervical spine facture with halo fixator is safe and effective.     

Ambulatory blood pressure monitoring in renal transplant patients: should it be routinely performed?

Introduction

Arterial hypertension is common among kidney transplant patients. It increases cardiovascular risk and is a factor for progression of renal failure. Our objective was to perform ambulatory blood pressure monitoring (ABPM) in renal transplant patients with office hypertension.

Methods

Patients were divided into 2 groups according to their mean ABPM blood pressures with treatment: well-controlled hypertension (blood pressure [BP] <130/85 mmHg), and poorly controlled hypertension (BP > 130/85 mmHg). A “nondipper pattern” was defined as a decrease of <10% or an increase, and a “raiser pattern,” in which mean blood pressure was greater during the nocturnal than the diurnal period. “White coat effect” was considered when the mean of 3 BP measurements in the clinic was >140/90 mmHg among well-controlled hypertensive patients as documented by ABPM.

Results

ABPM was performed in 53 patients: 25 (47%) “well-controlled hypertensives” and 28 (53%) “poorly controlled hypertensives.” Of the latter, 24 (85%) showed a nondipper or raiser pattern with only 4 revealing dipper patterns. We compared well-controlled with poorly controlled hypertensives. The latter cohort were older (54.4 ± 9.3 vs 45.5 ± 13.8 years; P = .009), received grafts from older donors (56.7 ± 15.0 vs 45.8 ± 17 years; P = .02); had worse renal function measured by serum creatinine (1.7 ± 0.5 vs 1.4 ± 0.4 mg/dL, P = .03) or the Modification of Diet in Renal Disease (MDRD) = 4 formula (41.8 ± 14.0 vs 55.4 ± 20.5 mL/min/1.73 m²; P = .009), and displayed more proteinuria (0.30 ± 0.33 vs 0.18 ± 0.10 g/d, P = .08). Nondipper or raiser patients showed a higher mean body mass index (27.1 vs 21.7 kg/m²; P = .04). Among 25 well-controlled patients, 11 presented “white coat phenomenon.”

Conclusion

We observed an important “white coat” effect, a large prevalence of uncontrolled nocturnal hypertension, and a small but important incident of “masked hypertension.” Factors related to hypertension control were patient age, donor age, renal function, induction use, and proteinuria.