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Published on: April 12, 2021
Use of cardioprotective medications in kidney transplant recipients
R S Gaston1, B L Kasiske, A M Fieberg
1University of Alabama at Birmingham, Birmingham, AL, USA. rgaston@uab.edu
Insights
Cardioprotective medication use is highly variable in kidney transplant patients, particularly for those with cardiovascular disease or diabetes. This variability may stem from clinical uncertainty due to a lack of randomized trials.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Cardiovascular disease (CVD) is the leading cause of death in kidney transplant recipients with functioning grafts.
- Optimal use of cardioprotective medications in this high-risk population remains unclear.
Purpose of the Study:
- To examine the prescribing patterns of cardioprotective medications in kidney transplant recipients.
- To identify variability in medication use across transplant centers.
Main Methods:
- Prospective observational study at seven US and Canadian transplant centers.
- Inclusion of 935 kidney transplant recipients.
- Analysis of antihypertensive, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), aspirin, and statin use at 1 and 6 months post-transplant.
Main Results:
- While 87% received antihypertensives, ACEI/ARB use dropped significantly post-transplant (44% to 24%) and was low in patients with CVD or diabetes (<30%).
- Aspirin use was uncommon (<40%), and statin use was suboptimal (<60%) even in high-risk patients.
- Significant variability in medication prescribing was observed among centers.
Conclusions:
- Marked variability exists in the use of cardioprotective medications in kidney transplant recipients.
- Clinical uncertainty, potentially due to the lack of randomized trials, may explain prescribing patterns.
- Further research is needed to establish evidence-based guidelines for cardioprotective therapy in this population.
Abstract:
Death with function causes half of late kidney transplant failures, and cardiovascular disease (CVD) is the most common cause of death in these patients. We examined the use of potentially cardioprotective medications in a prospective observational study at seven transplant centers in the United States and Canada. Among 935 patients, 87% received antihypertensive medications at both 1 and 6 months after transplantation. Similar antihypertensive regimens were used for patients with and without diabetes and CVD, but with wide variability among centers. In contrast, while 44% of patients were on angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) at the time of transplantation, the proportion taking these agents dropped to 12% at month 1, then increased to 24% at 6 months. Fewer than 30% with CVD or diabetes received ACEI/ARB therapy 6 months posttransplant. Aspirin use was uncommon (<40% of patients). Even among those with diabetes and/or CVD, fewer than 60% received aspirin and only half received a statin at 1 and 6 months. This study demonstrates marked variability in the use of cardioprotective medications in kidney transplant recipients, a finding that may reflect, among several possible explanations, clinical uncertainty due the lack of randomized trials for these medications in this population.
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01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:26Kidney Transplant II: Surgical Procedure
01:22Heart Failure Drugs: Diuretics
01:16Kidney Transplant III: Nursing Management
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention