Is RAS blockade routinely indicated in hypertensive kidney transplant patients?

Abstract

There is a high incidence of hypertension after kidney transplantation, which has been associated with the development of left ventricular hypertrophy, an increased risk for acute rejection, lower graft survival, and increased mortality. The pathogenesis of post-transplant hypertension is multifactorial, and therefore optimum therapy for it is not clearly defined. Historically, use of renin-angiotensin system (RAS) blockade in post-transplant hypertension has been limited given concerns of inducing worsening allograft function. Recent data demonstrated that subjects with post-transplant hypertension can be treated effectively with RAS blockers, and that these agents may offer significant additional benefits beyond blood pressure control. Review of the literature suggests that RAS blockers should be considered as useful agents for treatment of post-transplant hypertension not due to transplant renal artery stenosis.

Chronic Allograft Nephropathy

“…This fact is due to the cardioprotective and renoprotective effects of renin-angiotensin system (RAS) blockade in the general population (Braunwald et al, 2004) and in patients with chronic kidney disease (Ruggenenti et al, 1997). A particular caution should be taken when using these agents in kidney transplant patients, as in the presence of artery stenosis of the graft the use of RAS inhibitors may dramatically increase the risk of kidney function impairment and hyperkalemia (Salzberg et al, 2007). However, the multifactorial nature of hypertension in transplanted patients often requires multiple drugs, including -or -blockers, centrally acting drugs, and diuretics (Ojo et al, 2006).…”

After the Kidney Transplant - The Patients and Their Allograft

“…This fact is due to the cardioprotective and renoprotective effects of renin-angiotensin system (RAS) blockade in the general population (Braunwald et al, 2004) and in patients with chronic kidney disease (Ruggenenti et al, 1997). A particular caution should be taken when using these agents in kidney transplant patients, as in the presence of artery stenosis of the graft the use of RAS inhibitors may dramatically increase the risk of kidney function impairment and hyperkalemia (Salzberg et al, 2007). However, the multifactorial nature of hypertension in transplanted patients often requires multiple drugs, including or -blockers, centrally acting drugs, and diuretics .…”

Molecular remodeling of the renin-angiotensin system after kidney transplantation

“… 13 , 14 So far, human RAS analyses after KTX have mainly focused on clinical outcomes with conflicting findings regarding beneficial versus detrimental effects of RAS blockade. 15 – 17 Recently, plasma renin activity and aldosterone concentration were measured serially in kidney transplant recipients for five years. 17 Here, relatively normal values were found in the majority of patients.…”