Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Type 1 Receptor Antagonist Therapy Is Associated with Prolonged Patient and Graft Survival after Renal Transplantation

Heinze, Georg; Mitterbauer, Christa; Regele, Heinz; Kramar, Reinhard; Winkelmayer, Wolfgang C.; Curhan, Gary C.; Oberbauer, Rainer

doi:10.1681/asn.2005090955

Cited by 251 publications

(145 citation statements)

References 33 publications

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“…Our findings are consistent with a recent report by Molnar et al (8), who, in a prospective cohort study, found that anemia at baseline significantly predicted mortality and graft failure over 4 yr follow-up and with two retrospective studies that demonstrated that PTA at 12 mo (defined as Hb Ͻ12 g/dl) was associated with decreased patient and graft survival (10) and that lower Hb was associated with adverse outcomes, including mortality and graft loss in renal tx patients (20).…”

Section: Discussionsupporting

confidence: 93%

Impact of Anemia after Renal Transplantation on Patient and Graft Survival and on Rate of Acute Rejection

Chhabra

Grafals²,

Skaro

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: The impact of posttransplantation anemia on patient survival, renal allograft survival, and rate of acute rejection is not known.Design, setting, participants, & measurements: A total of 1023 patients who underwent kidney transplantation at one center from January 1992 through June 2003 were retrospectively analyzed. Posttransplantation anemia was defined as mean hemoglobin <11 g/dl after 3 mo after transplantation. Data on demographics, pretransplantation dialysis, previous transplant history, pretransplantation hemoglobin, degree of HLA mismatch, and donor characteristics were collected. Some of the posttransplantation data that were collected in addition to the hemoglobin included delayed graft function; diabetes; hypertension; induction and maintenance of immunosuppressive regimen; posttransplantation infections; and use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, statins, aspirin, and ␤ blockers. Cox regression models were used to assess the effects of posttransplantation anemia on each outcome: Mortality, graft survival, and rate of acute rejection. Median follow-up time was 4 yr.Results: During the entire follow-up period, there were 89 (9%) deaths, 143 (14%) acute rejection episodes, and 235 (23%) kidney losses. In multivariate Cox regression models, being anemic after transplantation, after the first 90 d, was associated with increased overall mortality and increased renal allograft loss. Posttransplantation anemia was also associated with increased acute rejection rates.Conclusions: This study shows that posttransplantation anemia is associated with worse patient and graft survival and higher rates of acute rejection when compared with nonanemic renal transplant recipients.

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Section: Discussionsupporting

confidence: 93%

Impact of Anemia after Renal Transplantation on Patient and Graft Survival and on Rate of Acute Rejection

Chhabra

Grafals²,

Skaro

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…A single-center retrospective study suggested that use of these agents was associated with improved allograft and patient survival but not deathcensored graft survival (24). A larger registry analysis concluded that the use of these agents had no benefit on either patient or graft survival (25).…”

Section: Hypertensionmentioning

confidence: 99%

Metabolic Syndrome in Kidney Transplantation

Hricik¹

2011

Clinical Journal of the American Society of Nephrology

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The metabolic syndrome is a constellation of clinical abnormalities related to insulin resistance and inflammation. The syndrome is now recognized as a risk factor for diabetes and cardiovascular disease in the general population. Recent studies suggest that the metabolic syndrome is common after kidney transplantation, also possibly being predictive of allograft loss and poor allograft function. The development or worsening of obesity plays a central role in the development of metabolic syndrome after kidney transplantation. Immunosuppression also plays an important role in the pathogenesis of the individual components of the metabolic syndrome. In fact, the overriding influence of immunosuppressive medications makes it unclear whether the metabolic syndrome has the same value in predicting outcomes as is true in the general population. However, recent studies suggest that the presence of metabolic syndrome before transplantation predicts the subsequent development of new-onset diabetes after transplantation, independent of other widely known risk factors. Aggressive management of the metabolic syndrome is warranted both before and after transplantation.

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“…In renal transplant recipients, microalbuminuria is a risk factor for graft loss and all-cause mortality (17). The effectiveness of RAS inhibitors for decreasing proteinuria following renal transplantation has been evaluated in various studies (16,(18)(19)(20). Heinze et al (18) demonstrated that treatment with ACEi and/or ARB led to a 45 and 43% reduction in the risk of graft loss and patient mortality, respectively.…”

Section: Discussionmentioning

confidence: 99%

Albuminuria-reducing effect of angiotensin II receptor blocker plus hydrochlorothiazide combination therapy in renal transplant recipients

Naganuma

Takemoto

Uchida

et al. 2012

Experimental and Therapeutic Medicine

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Abstract. In recent years, the combined use of angiotensin II receptor blockers (ARBs) and low-dose diuretics has become clinically possible. Moreover, the GUARD and J-CORE studies have confirmed that the addition of low-dose diuretics to renin-angiotensin system inhibitors reduces albuminuria. In this study, we investigated the clinical effects of a combination drug containing an ARB and a low-dose diuretic in renal transplant recipients. A total of 13 renal transplant recipients who were receiving the maximum dose of the ARB and presenting with microalbuminuria [urine albumin-creatinine ratio (ACR) of 30-300 mg/g-Cre] were converted to a single pill combination drug containing the same amount of the ARB and 12.5 mg of hydrochlorothiazide (HCTZ) and an intervention study of a crossover trial design was conducted. The clinical parameters were measured at baseline, 3 months after ARB/HCTZ conversion and 3 months after reverting to the ARB and the resulting data were compared. Serum creatinine (S-Cre) and uric acid (UA) levels at 3 months after conversion were significantly higher than those at baseline. The levels of the estimated glomerular filtration rate (eGFR) and ACR at 3 months were significantly lower than those at baseline. S-Cre and UA levels at 3 months after reversion were significantly lower than those at 3 months after conversion. The eGFR and levels of ACR and UA at 3 months after ARB reversion were significantly higher than those at 3 months after conversion. The results of this preliminary study suggest that the combination drug containing an ARB and low-dose diuretic was effective for reducing microalbuminuria in renal transplant recipients. In the future, larger cohort studies are needed to confirm these findings.

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Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Type 1 Receptor Antagonist Therapy Is Associated with Prolonged Patient and Graft Survival after Renal Transplantation

Cited by 251 publications

References 33 publications

Impact of Anemia after Renal Transplantation on Patient and Graft Survival and on Rate of Acute Rejection

Impact of Anemia after Renal Transplantation on Patient and Graft Survival and on Rate of Acute Rejection

Metabolic Syndrome in Kidney Transplantation

Albuminuria-reducing effect of angiotensin II receptor blocker plus hydrochlorothiazide combination therapy in renal transplant recipients

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