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Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Angiotensin converting enzyme inhibitor use soon after renal transplantation: a randomized, double-blinded
Daniel Glicklich1, Roberto Gordillo, Katarina Supe
1Department of Medicine, Montefiore Medical Center of the Albert Einstein College of Medicine, Bronx, NY 10467, USA. dglichli@montefiore.org
Abstract:
Activation of the renin-angiotensin system (RAS) followed by increased inflammatory cytokines may be important in the pathogenesis of chronic allograft dysfunction. As many renal transplant recipients show chronic changes on biopsy within the first year, early RAS blockade with angiotensin converting enzyme inhibitor (ACEI) could be beneficial. However, it remains unclear that early ACEI use is safe. We conducted a prospective, randomized, placebo-controlled trial to assess the safety of enalapril 5 mg during the early post-transplant period. Subjects took the study medication for six months. Primary endpoints were serum potassium (K) >5.9 mEq/L and 30% increase in baseline creatinine. A total of 53 subjects were randomized, and of them, 27 received the study drug. Twenty-nine subjects, 14 ACEI and 15 controls, completed the six-month protocol without reaching an endpoint. Patients on ACEI had higher K and higher BUN at six months. Serum creatinine, hematocrit, and urinary protein were not different. There was no difference in urinary TGF-β1. Twenty-four subjects reached study endpoints. When the common clinical endpoints of elevated creatinine and hyperkalemia were combined, ACEI group had significantly increased endpoints vs. control (10/13, 77% vs. 5/11, 45%, p < 0.05). We conclude that ACEI use in the early post-transplant period can be safe but patients must be carefully selected and monitored for elevations in serum creatinine and potassium. Whether early ACEI is beneficial in preserving allograft function requires further study.
Insights
Early use of angiotensin converting enzyme inhibitors (ACEI) in kidney transplant patients showed increased risk of hyperkalemia and elevated creatinine. Careful patient selection and monitoring are crucial for safe ACEI administration post-transplant.
Area of Science:
- Nephrology
- Immunology
- Pharmacology
Background:
- Chronic allograft dysfunction pathogenesis may involve renin-angiotensin system (RAS) activation and inflammatory cytokines.
- Renal transplant recipients often exhibit chronic changes within the first year, suggesting potential benefits of early RAS blockade.
Purpose of the Study:
- To assess the safety of early post-transplant enalapril (an ACEI) administration.
- To evaluate the incidence of hyperkalemia and creatinine elevation in early renal transplant recipients receiving enalapril.
Main Methods:
- Prospective, randomized, placebo-controlled trial.
- 53 subjects randomized, with 27 receiving enalapril 5 mg for six months.
- Primary endpoints: serum potassium >5.9 mEq/L or 30% increase in baseline creatinine.
Main Results:
- Patients on ACEI had higher serum potassium and blood urea nitrogen (BUN) at six months.
- Combined endpoints of elevated creatinine and hyperkalemia were significantly increased in the ACEI group (77% vs. 45%, p < 0.05).
- No significant differences in serum creatinine, hematocrit, urinary protein, or urinary TGF-β1.
Conclusions:
- Early ACEI use in renal transplantation can be safe but necessitates careful patient selection and monitoring for adverse events.
- Further studies are required to determine the efficacy of early ACEI in preserving allograft function.
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