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Published on: May 26, 2022
Renin-angiotensin system blockade and kidney transplantation: a longitudinal cohort study
Domingo Hernández1, Alfonso Muriel, Víctor Abraira
1Nephrology Department, Hospital Regional Universitario Carlos Haya, Málaga, Spain. domingohernandez@gmail.com
Background:
The beneficial effect of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) in kidney transplant recipients on modern immunosuppression is not yet well established. Our objective was to investigate the impact of the use of ACEI/ARB on patient and graft survival in a cohort of kidney transplant recipients.
Methods:
A total of 990 patients, who received a single deceased donor kidney at our institution between 1996 and 2005, were included in this longitudinal cohort study. All-cause mortality and death-censored graft loss were the primary outcomes. We used traditional time-dependent Cox model (unweighted) and inverse-probability-of-treatment weighting of marginal structural models (weighted Cox model), controlling for time-dependent confounding by indication.
Results:
A total of 414 patients (42%) received ACEI/ARB through the study period (median duration 14 months, interquartile range 6-40 months). ACEI/ARB use was associated with reduction of risk for mortality in the crude [hazard ratio (HR) 0.627, 95% confidence interval (CI) 0.412-0.953] and adjusted Cox analysis (HR 0.626, 95% CI 0.407-0.963). Similar results were observed after adjusting for confounding by indication (HR 0.629, 95% CI 0.407-0.973). By contrast, ACEI/ARB use was not associated with significant improvement of graft survival after kidney transplantation.
Conclusion:
ACEI/ARB prescription may be suggested as beneficial among multiple medications for reducing mortality in kidney transplant recipients, but its use was not associated with longer graft survival.
Insights
Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) may reduce mortality in kidney transplant recipients. However, this study found no significant association between ACEI/ARB use and improved graft survival in these patients.
Area of Science:
- Nephrology
- Transplantation Medicine
- Pharmacology
Background:
- The role of ACEI/ARB in kidney transplant recipients on modern immunosuppression requires further clarification.
- Investigating the impact of ACEI/ARB on patient and graft survival is crucial for optimizing post-transplant care.
Purpose of the Study:
- To evaluate the effect of ACEI/ARB on patient and graft survival in kidney transplant recipients.
- To establish the established benefit of ACEI/ARB in kidney transplant recipients.
Main Methods:
- A longitudinal cohort study included 990 kidney transplant recipients from 1996-2005.
- Primary outcomes were all-cause mortality and death-censored graft loss.
- Time-dependent Cox models, including weighted marginal structural models, controlled for confounding by indication.
Main Results:
- ACEI/ARB use (42% of patients) was associated with a reduced risk of mortality (HR 0.626, 95% CI 0.407-0.963) in adjusted analyses.
- This mortality benefit persisted after adjusting for confounding by indication (HR 0.629, 95% CI 0.407-0.973).
- No significant association was found between ACEI/ARB use and improved graft survival.
Conclusions:
- ACEI/ARB prescription may be beneficial for reducing mortality in kidney transplant recipients.
- However, ACEI/ARB use was not linked to enhanced graft survival in this cohort.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:25Antihypertensive Drugs: Direct Renin Inhibitors
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:26Kidney Transplant II: Surgical Procedure
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
01:16Kidney Transplant III: Nursing Management