Databases searched: MeSH terms and text words for kidney transpla

Databases searched: MeSH terms and text words for kidney transplantation were combined with MeSH terms and text words for living donor, and combined with MeSH terms and text words for hypertension. The search was carried out in Medline (1950–July Week 3, 2008). The Cochrane

Renal Group Trials Register was also searched for trials not indexed in Medline. Date of searches: 24 July 2008. Assessment of living donors’ BP should consider the long-term cardiovascular risk and the presence of hypertension as a surrogate marker of underlying renal disease. The definition of hypertension and how BP should be measured requires some consideration. There is a well-established relationship between cardiovascular risk and degree of hypertension, however, the threshold for concern has been progressively lowered in more recent years. The definition of ‘hypertension’ as a threshold of measurement has been generally considered to be 140/90 mmHg, however, the most recent Joint National Committee now defines increased cardiovascular risk for individuals previously considered to be in the ‘normal’ range, and define a group of patients as ‘pre-hypertension’ with BP readings 120–140 systolic/80–90 diastolic.1 The implication of this redefinition of risk for these patients previously considered to be in

the normal range has not been evaluated for living donors. The method of BP measurement is an additional variable that needs further consideration. Assessment of live donors should YAP-TEAD Inhibitor 1 include serial manual BP measurements on at least three separate outpatient visits as a minimum evaluation. The majority of studies evaluating BP measurement in the general population relating measurement to cardiovascular risk and morbidity have relied on manual measurement. The role of ABPM continues to be evaluated and has been shown to correlate with end-organ damage2 and predict cardiovascular risk better than manual BP measurement in some studies.3,4 If elevated manual BP is detected, then it may be worthwhile performing home self-BP measurements or ABPM, since 10–20% of patients with

elevated manual measurements have normal BP by ABPM.5–7 A normal BP on home BP measurements or ABPM is an average of less than 135/85 mmHg. If hypertension is detected evidence of end-organ disease should be excluded by echocardiogram next and ophthalmology assessment. Patients with evidence of end-organ damage should not be considered as donors, including potential donors with poorly controlled BP or those taking multiple antihypertensives. In addition to detecting patients with ‘white-coat’ hypertension, ABPM may also improve the detection of hypertension. Ozdemir et al. studied renal donors and demonstrated that ABPM was more sensitive at detecting hypertensive patients than manual BP.5 Textor et al. also reported that ABPM is useful in the diagnosis of hypertension in renal donors, particularly the elderly.

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