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The Effect of Renin-angiotensin System Inhibitors on Kidney Allograft Survival: A Systematic Review and Meta-analysis
Wisit Cheungpasitporn1, Charat Thongprayoon1, Michael A Mao1
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
Background:
The use of renin-angiotensin system (RAS) inhibitors in patients with chronic kidney disease, and especially in diabetic kidney disease, has been shown to provide renoprotective effects and slow progression to end-stage renal disease. However, this protective effect in kidney transplant patient populations is unclear.
Aim:
The objective of this systematic review and meta-analysis was to evaluate the effect of RAS inhibitors on kidney allograft survival.
Materials And Methods:
A literature search for randomized controlled trials (RCTs) was performed from inception through February 2016. Studies that reported relative risks or hazard ratios comparing the risks of renal graft loss in renal transplant recipients who received RAS inhibitors vs. controls were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method.
Results:
Five studies (3 RCTs and 2 cohort studies) with 20024 kidney transplant patients were included in the meta-analysis. Pooled RR of allograft failure in recipients who received RAS inhibitors was 0.73 (95% CI: 0.45-1.21). When meta-analysis was limited only to RCTs, the pooled RR of allograft failure in patients using RAS inhibitors was 0.59 (95%: CI 0.20-1.69). The risk for mortality (RR: 1.13 [95% CI: 0.62-2.07]) in patients using RAS inhibitors compared to controls was not significantly reduced.
Conclusion:
This meta-analysis demonstrated insignificant reduced risks of renal graft loss among renal transplant recipients who received RAS inhibitors. Future studies assessing the potential benefits of RAS inhibitors on allograft survival in specific kidney transplant patient populations are needed.
Insights
Renin-angiotensin system (RAS) inhibitors did not significantly reduce renal graft loss in kidney transplant recipients. Further research is needed to explore potential benefits in specific patient groups.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pharmacology
Background:
- Renin-angiotensin system (RAS) inhibitors are known to protect kidneys in chronic and diabetic kidney disease.
- Their efficacy in kidney transplant recipients regarding allograft survival remains uncertain.
Purpose of the Study:
- To systematically review and meta-analyze the impact of RAS inhibitors on kidney allograft survival.
Main Methods:
- A comprehensive literature search identified randomized controlled trials (RCTs) and cohort studies up to February 2016.
- Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for renal graft loss and mortality.
Main Results:
- The meta-analysis of five studies (20,024 patients) showed a non-significant RR of 0.73 for allograft failure with RAS inhibitors.
- Limiting analysis to RCTs yielded a pooled RR of 0.59 for allograft failure.
- RAS inhibitors did not significantly reduce mortality risk (RR: 1.13).
Conclusions:
- RAS inhibitors did not demonstrate a significant reduction in renal graft loss for kidney transplant recipients.
- Further studies are required to identify specific kidney transplant patient populations that may benefit from RAS inhibitors.
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