title: Native Nephrectomy with Renal Transplantation is Associated with a Decrease in Hypertension Medication Requirements for Autosomal Dominant Polycystic Kidney Disease.
abstract: OBJECTIVE
  We assessed hypertensive control after native nephrectomy and renal transplantation in patients with autosomal dominant polycystic kidney disease.
  
  
  METHODS
  Blood pressure control was studied retrospectively in 118 patients with autosomal dominant polycystic kidney disease who underwent renal transplantation between 2003 and 2013. Overall 54 patients underwent transplantation alone (group 1) and 64 underwent transplantation with concurrent ipsilateral nephrectomy (group 2). Of these 64 patients 32 underwent ipsilateral nephrectomy only (group 2a) and 32 underwent eventual delayed contralateral native nephrectomy (group 2b). The number of antihypertensive drugs and defined daily dose of each antihypertensive was recorded at transplantation and up to 36-month followup.
  
  
  RESULTS
  Comparing preoperative to postoperative medications at 12, 24 and 36-month followup, transplantation with concurrent ipsilateral nephrectomy had a greater decrease in quantity (-1.2 vs -0.5 medications, p=0.008; -1.1 vs -0.3, p=0.007 and -1.2 vs -0.4, p=0.03, respectively) and defined daily dose of antihypertensive drug (-3.3 vs -1.0, p=0.0008; -2.9 vs -1.0, p=0.006 and -2.7 vs -0.6, p=0.007, respectively) than transplantation alone at each point. Native nephrectomy continued to be a predictor of hypertensive requirements on multivariable analysis (p <0.0001). The mean decrease in number of medications in group 2b from after ipsilateral nephrectomy to 12 months after contralateral nephrectomy was -0.6 (p=0.0005) and the mean decrease in defined daily dose was -0.6 (p=0.009).
  
  
  CONCLUSIONS
  In patients with autosomal dominant polycystic kidney disease undergoing renal transplantation, concurrent ipsilateral native nephrectomy is associated with a significant decrease in the quantity and defined daily dose of antihypertensive drugs needed for hypertension control. Delayed contralateral native nephrectomy is associated with improved control of blood pressure to an even greater degree.
authors: Department of Urology, Indiana University, Indianapolis, Indiana.
authors: Ashley M
authors: AM
authors: Shumate
authors: Department of Urology, Indiana University, Indianapolis, Indiana.
authors: Clinton D
authors: CD
authors: Bahler
authors: Department of Surgery, Indiana University, Indianapolis, Indiana.
authors: William C
authors: WC
authors: Goggins
authors: Department of Medicine/Division of Nephrology, Indiana University, Indianapolis, Indiana.
authors: Asif A
authors: AA
authors: Sharfuddin
authors: Department of Urology, Indiana University, Indianapolis, Indiana. Electronic address: sundaram@iupui.edu.
authors: Chandru P
authors: CP
authors: Sundaram
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage*; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents
keywords: autosomal dominant; drug dosage calculations; hypertension; kidney transplantation; nephrectomy; polycystic kidney