Management of hypertension and factors affecting its control in Jordanian renal transplant recipients.

BACKGROUND: Hypertension affects 70-90 % of all kidney transplant recipients. It is associated with poor graft survival and is a contributing factor to the increased cardiovascular mortality. The reasons for the insufficient blood pressure control in transplanted patients have not been thoroughly investigated. OBJECTIVE: To evaluate the extent of blood pressure control in Jordanian hypertensive renal transplant recipients and to assess factors associated with such control. SETTING: Three outpatient renal transplant clinics in Amman. METHOD: A cross-sectional observational study including 181 patients. We have considered blood pressure <130/80 mm Hg as controlled hypertension. Bivariate and multivariate logistic regression analyses were used to determine clinical factors associated with achievement of blood pressure control. MAIN OUTCOME MEASURES: Proportion of patients who achieved hypertension control and clinical factors associated with good blood pressure control. RESULTS: Mean systolic blood pressure was 128.6 ± 16.3 mm Hg and mean diastolic blood pressure was 82.8 ± 11.5 mm Hg. Blood pressure control was achieved only in 58 % of patients. The most commonly prescribed antihypertensives were calcium channel blockers (58 %) followed by beta-blockers (44 %). In bivariate analysis, female gender (p = 0.017) and creatinine clearance (p = 0.002) were positively associated, while number of antihypertensive medications was inversely associated (p = 0.04) with achievement of blood pressure control. After including these factors in multivariate logistic regression analysis, only creatinine clearance remained independently associated with hypertension control (odds ratio, OR 1.04; 95 % confidence interval [CI] 1.01-1.06; p = 0.003). CONCLUSION: Blood pressure control among renal transplant recipients in Jordan was found to be inadequate. The only factor found to be independently associated with adequate blood pressure control was creatinine clearance.

The spectrum of bone disease in Jordanian hemodialysis patients.

OBJECTIVE: To evaluate the spectrum of mineral abnormalities and bone disease (BD) in hemodialysis patients at Jordan University Hospital (JUH), Amman, Jordan. METHODS: A cross-sectional study was conducted among 63 patients (38 males and 25 females), mean age 44.19 years (range 17-76 years), with chronic kidney disease (CKD) on regular hemodialysis at JUH between November 2004 and April 2005. All patients have undergone complete blood count, chemistry profile, alkaline phosphatase, serum albumin, intact parathyroid hormone (iPTH) and plain x-rays. RESULTS: Bone disorders were identified in 45 patients on x-rays (70%). Osteopenia was found in 43 patients (68.3%), subperiosteal resorption in 24 patients (38.3%) and metastatic calcification in 22 patients (35%). Hypocalcemia was found in 28.6% and hypercalcemia in 7.9%. All patients were taking calcium carbonate, and 55.5% of patients were on vitamin D supplements. The calcium levels in 63.5% and the phosphorus levels in 50.8% of patients were within the recommended guidelines of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI). Serum i-PTH level was above 300 pg/ml high turnover bone disease in 24.6% of patients, 21.3% had iPTH of 150-300 pg/ml target, and 44.3% had i-PTH levels below 100 pg/mL suggesting a dynamic bone disease. Patients with severe bone disease had a statistically significant higher iPTH levels (p<0.005). CONCLUSION: Bone disease and mineral abnormalities are common in hemodialysis patients at JUH. Earlier detection of bone disease and better overall management strategy may reduce the frequency and severity of bone disease in CKD patients in Jordan.