A randomized placebo-controlled study of enalapril in the treatment of erythrocytosis after renal transplantation

Beckingham, I. J.; Woodrow, Graham; Hinwood, M.; Rigg, Keith; Morgan, A. G.; Burden, Richard; Broughton-Pipkin, Fiona

doi:10.1093/ndt/10.12.2316

Cited by 29 publications

(22 citation statements)

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“…Three trials were performed in the United States; one each was from the United Kingdom, Japan and Egypt, with the remainder from Europe. Fourteen trials were of a parallel design (10,12,17–28) while seven were crossover studies (29–35). The trials were small with a median sample size of 31.…”

Section: Resultsmentioning

confidence: 99%

Renin Angiotensin System Blockade in Kidney Transplantation: A Systematic Review of the Evidence

Hiremath¹,

Fergusson²,

Doucette³

et al. 2007

American Journal of Transplantation

174

111

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Section: Resultsmentioning

confidence: 99%

Renin Angiotensin System Blockade in Kidney Transplantation: A Systematic Review of the Evidence

Hiremath¹,

Fergusson²,

Doucette³

et al. 2007

American Journal of Transplantation

174

111

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“…There are a number of small RCTs of fair quality and case series demonstrating the use of ACE‐Is or ARBs to reduce hematocrit by an absolute value of between 4% and 15% (785–797). Given the small sample sizes and the lack of data on critical clinical outcomes, there is only a low level of evidence (see Evidence Profile and accompanying evidence in Supporting Tables 56–58).…”

Section: Rationalementioning

confidence: 99%

“…Given the small sample sizes and the lack of data on critical clinical outcomes, there is only a low level of evidence (see Evidence Profile and accompanying evidence in Supporting Tables 56–58). In a RCT comparing enalapril (2.5 mg/day, n = 15) to placebo (n = 10), the hematocrit dropped by 6.6% in the treatment arm compared to only 1.3% in the control arm (p = 0.004) (788). In another small trial, 15 patients were randomized to an ACE‐I (enalapril) and 12 patients an ARB (losartan) (796).…”

Section: Rationalementioning

confidence: 99%

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Eckardt¹,

Kasiske²,

Zeier³

2009

American Journal of Transplantation

1,166

294

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Journal compilation © 2009 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/j.1600-6143.2009.02834.x S2 American Journal of Transplantation 2009; 9 (Suppl 3): S2-S2Since the first successful kidney transplantation in 1954 It is our hope that this document will serve several useful purposes. Our primary goal is to improve patient care. We hope to accomplish this in the short term by helping clinicians know and better understand the evidence (or lack of evidence) that determines current practice. By making this guideline broadly applicable, our purpose is to also encourage and enable the establishment and development of transplant programs worldwide. Finally, by providing comprehensive evidence-based recommendations, this guideline will also help define areas where evidence is lacking and research is needed. Helping to define a research agenda is an often neglected, but very important function of clinical practice guideline development.We used the GRADE system to rate the strength of evidence and the strength of recommendations. In all, there were only 4 (2%) recommendations in this guideline for which the overall quality of evidence was graded 'A,' whereas 27 (13.6%) were graded 'B,' 77 (38.9%) were graded 'C,' and 90 (45.5%) ' and 148 (74.7%) graded '2.' There were 3 (1.5%) recommendations graded '1A,' 16 (8.1%) were '1B,' 18 (9.1%) were '1C, ' and 13 (6.6%) were '1D.' There was 1 (0.5%) graded '2A,' 11 (5.6%) were '2B,' 59 (29.8%) were '2C, ' and 77 (38.9%) BackgroundExcept perhaps for transplantation between identical twins, all kidney transplant recipients (KTRs) need immunosuppressive medications to prevent rejection. Induction therapy is treatment with a biologic agent, either a lymphocyte-depleting agent or an interleukin 2 receptor antagonist (IL2-RA), begun before, at the time of, or immediately after transplantation. The purpose of induction therapy is to deplete or modulate T-cell responses at the time of antigen presentation. Induction therapy is intended to improve the efficacy of immunosuppression by reducing acute rejection, or by allowing a reduction of other components of the regimen, such as calcineurin inhibitors (CNIs) or corticosteroids. Available lymphocytedepleting agents include antithymocyte globulin (ATG), antilymphocyte globulin (ALG) and monomurab-CD3. Basiliximab and daclizumab, the two IL2-RAs that are currently available in many parts of the world, bind the CD25 antigen (interleukin-2 [IL2] receptor a-chain) at the surface of activated T-lymphocytes and thereby competitively inhibit IL2-mediated lymphocyte activation, a crucial phase in cellular immune response of allograft rejection. Rationale• There is high-quality evidence that the benefits of IL2-RA vs. no IL2-RA (or placebo) outweigh harm in a broad range of KTRs with variable immunological risk and concomitant immunosuppressive medication regimens.• There is moderate-quality evidence that a lymphocytedepleting agent vs. no lymphocyte-depleting a...

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“…It is associated with an increased risk of complications due to thromboembolic events and has traditionally been treated by intermittent venesection. Recently, inactivation of RAS by an ACE inhibitor, or an ARB represents the most effective, safe, and well‐tolerated therapeutic modality 8. In our study, 28 patients out of 120 consecutive kidney transplanted patients who retained a functional graft had a 23.3% incidence of PTE.…”

Section: Discussionmentioning

confidence: 65%

Post‐kidney transplantation erythrocytosis and its relationship to renal artery stenosis, IGF‐1, and its binding protein 3 (IGFBP‐3)

Khedr

Abdelwhab

ElSharkawy

et al. 2009

Dialysis & Transplantation

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Background Erythrocytosis is relatively common following kidney transplantation. It increases the risk of thromboembolism. Insulin‐like growth factor‐1 (IG‐1) and its binding protein 3 (IGFBP‐3) may play a role in its pathogenesis. Patients and Methods A total of 120 consecutive kidney‐transplanted patients with at least 3 month graft function were studied. Forty‐five kidney transplant patients were then selected and divided into 2 groups: 15 patients with post‐transplant erythrocytosis (PTE; group I), 30 without erythrocytosis (group II), and 15 healthy subjects matched with the cases as a control group (group III). Full medical history, clinical examination, hematological parameters, routine biochemical tests, IGF‐1, and IGFBP‐3 were measured in all subjects. Duplex ultrasonography for diagnosis of renal artery stenosis was done. Results Post‐transplant erythrocytosis developed with an incidence rate of 23.3%. The serum of IGF‐1 was significantly higher in the renal transplant recipients with and without erythrocytosis (309.4 ± 72.9, 301.6 ± 67.5 ng/mL, respectively) compared to controls (232.5 ± 95.3 ng/ml, p < 0.01), although there was no statistical difference between the first 2 groups. However, the serum of IGFBP‐3 was significantly higher in the renal transplant recipients with erythrocytosis than those without erythrocytosis and normal individuals (p < 0.001). Graft function and incidence of acute and chronic rejection were similar between the 2 groups. Conclusion Post‐transplant erythrocytosis represents an anomaly of IGF‐1 and its major binding proteins in which they may alter erythropoietin homeostatic mechanisms in the denervated transplant kidney which may be superimposed on a setting of multiple risk factors and leads to a state of erythrocytosis that is seen after kidney transplantation.

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A randomized placebo-controlled study of enalapril in the treatment of erythrocytosis after renal transplantation

Abstract: Angiotensin-converting enzyme inhibitors are a safe and effective form of treatment for erythrocytosis developing after renal transplantation. The mechanism of action, however, is not mediated by changes in erythropoietin production and remains uncertain.

Cited by 29 publications

References 0 publications

Renin Angiotensin System Blockade in Kidney Transplantation: A Systematic Review of the Evidence

Renin Angiotensin System Blockade in Kidney Transplantation: A Systematic Review of the Evidence

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Post‐kidney transplantation erythrocytosis and its relationship to renal artery stenosis, IGF‐1, and its binding protein 3 (IGFBP‐3)

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