Beta and Angiotensin Blockades Are Associated With Improved 10‐Year Survival in Renal Transplant Recipients

Aftab, Waqas; Varadarajan, Padmini; Rasool, Shuja; Kore, Arputharaj; Pai, Ramdas G.

doi:10.1161/jaha.112.000091

Cited by 26 publications

(11 citation statements)

References 46 publications

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“…RTRs usually have heightened activity of the sympathetic nervous system so therapy with BB may offer a survival benefit. Some observational reports showed that therapy with BB is associated with better long-term survival of RTRs [9]. These facts may have influenced the wide use of BB among our cohort of RTRs.…”

Section: Discussionmentioning

confidence: 89%

Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses

Kuźmiuk-Glembin

Adrych

Tylicki

et al. 2018

Kidney Blood Press Res

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Background/Aims: This retrospective study analysed hypertension management and adherence to blood pressure (BP) targets among renal transplant recipients (RTRs) under specialized care in the Outpatient Transplantation Unit in the Department of Nephrology, Transplantology and Internal Medicine at Gdansk University Hospital. Methods: Medical records of 101, 316, 639 and 818 RTRs diagnosed with hypertension, who received outpatient care in 2001, 2006, 2011 and 2014, respectively were analysed in four independent cross-sectional surveys. All RTRs received antihypertensive regimens. Results: The overall most commonly used antihypertensive agents were beta-blockers (BB) (range 66.3-82.5%) followed by calcium channel blockers (CCB) (range 52.8-64.2%). Whilst a significant, upward tendency of BB usage (p<0.01) was observed, CCB usage (p<0.001) displayed a downward tendency as a first line therapy in the subsequent years. The average number of antihypertensive agents used per patient increased significantly from 2.24±1.03 in 2001 to 2.55±1.25 in 2014 (p<0.05). The most frequently used combination of hypotensive therapy consisted of two or three antihypertensive drugs depending on the survey. The most common two drug combination consisted of BB and CCB followed by BB accompanied by angiotensin converting enzyme inhibitors. A significant, upward tendency in the use of four (p<0.001) and five (p<0.05) antihypertensive drugs simultaneously, was observed in subsequent years. The target values of BP i.e. <140/90 mmHg were accomplished in 47, 58, 60 and 46% of RTRs in subsequent years. In a secondary - stratified analysis of data from 2014, younger patients (p<0.05), patients with better graft function (p<0.001), patients treated with a higher number of antihypertensive agents (p<0.001) and those not treated with BB (p<0.01) were shown to reach the BP target of below 140/90 mmHg more often. Conclusion: The study showed intensification of hypertension treatment in RTRs in subsequent years with BB assuming a dominant role.

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Section: Discussionmentioning

confidence: 89%

Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses

Kuźmiuk-Glembin

Adrych

Tylicki

et al. 2018

Kidney Blood Press Res

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“…However, data from the United States Renal Data System indicate that only 20% of the chronic dialysis patients with heart failure were receiving beta-blocker therapy [11,13]. In a 10-year study of renal transplant patients, beta-blocker therapy was associated with improved survival (HR 0.61, p = 0.04) compared with not being on a beta-blocker, and this was consistent, regardless of the presence of HTN, diabetes, myocardial infarction or left ventricular dysfunction [14]. …”

Section: Discussionmentioning

confidence: 99%

Beta-Blocker Use Is Associated with Higher Renal Tissue Oxygenation in Hypertensive Patients Suspected of Renal Artery Stenosis

Hall

Rocco²,

Morgan

et al. 2016

Cardiorenal Med

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Background: Chronic renal hypoxia influences the progression of chronic kidney disease (CKD). Blood oxygen level-dependent (BOLD) magnetic resonance (MR) is a noninvasive tool for the assessment of renal oxygenation. The impact of beta-blockers on renal hemodynamics and oxygenation is not completely understood. We sought to determine the association between beta-blocker use, renal cortical and medullary oxygenation, and renal blood flow in patients suspected of renal artery stenosis. Methods: We measured renal cortical and medullary oxygenation using BOLD MR and renal artery blood flow using MR phase contrast techniques in 38 participants suspected of renal artery stenosis. Results: Chronic beta-blocker therapy was associated with improved renal cortical (p < 0.001) and medullary (p = 0.03) oxygenation, while the use of calcium channel blockers or diuretics showed no association with either cortical or medullary oxygenation. Receipt of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with reduced medullary oxygenation (p = 0.01). In a multivariable model, chronic receipt of beta-blockers was the only significant predictor of renal tissue oxygenation (β = 8.4, p = 0.008). Beta-blocker therapy was not associated with significant changes in renal artery blood flow, suggesting that improved renal oxygenation may be related to reduced renal oxygen consumption. Conclusions: In addition to known benefits to reduce cardiovascular mortality in patients with renal disease, beta-blockers may reduce or prevent the progression of renal dysfunction in patients with hypertension, diabetes, and renovascular disease, partly by reducing renal oxygen consumption. These observations may have important implications for the treatment of patients with CKD.

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“…Of these, we excluded 12 for the following reasons: 6 provided insufficient data; 4 study pairs investigated the same population, so we excluded the 4 with the shortest follow‐up, smallest population, or least complete outcome; 1 study was only reporting a protocol and 1 study used ACEI/ARBs in both the experimental and control arms. Therefore, 24 studies involving a total of 54,096 patients were included [26–49], of which 9 were RCTs (n = 1569) and 15 were cohort studies (n = 52,527).…”

Section: Resultsmentioning

confidence: 99%

Effect of renin‐angiotensin system inhibitors on survival in kidney transplant recipients: A systematic review and meta‐analysis

Jiang

Song

Qiu

et al. 2017

The Kaohsiung J of Med Scie

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Renin-angiotensin system inhibitors, specifically angiotensin II converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB), have confirmed renoprotective benefits in patients with proteinuria and hypertension. However, it remains controversial whether these agents are beneficial to kidney recipients. We conducted this meta-analysis to evaluate the effects of ACEI/ARB treatment on patient and allograft survival after kidney transplant. The PubMed, Embase and Cochrane Library databases were searched for eligible articles from before May 2016, and we included 24 articles (9 randomised controlled trials [RCTs] and 15 cohort studies with 54,096 patients), in which patient or graft survival was compared between an ACEI/ARB treatment arm and a control arm. Pooled results showed that ACEI/ARB was associated with decreased risks of patient death (relative risk [RR] = 0.64; 95% confidence interval [CI]:0.49-0.84) and graft loss (RR = 0.59; 95%CI:0.47-0.74). Subgroup analysis of the cohorts revealed significantly reduced patient death (RR = 0.61; 95%CI:0.50-0.74) and graft loss (RR = 0.58; 95%CI:0.46-0.73), but this was not seen in RCTs (patient survival: RR = 0.84, 95%CI:0.39-1.81; graft survival: RR = 0.70, 95%CI:0.17-2.79). Significantly less graft loss was noted among patients with biopsy-proved chronic allograft nephropathy (CAN) (RR = 0.26, 95%CI:0.16-0.44). Furthermore, the benefit of ACEI/ARB on patient survival (RR = 0.62; 95%CI:0.47-0.83) and graft survival (RR = 0.58, 95%CI:0.47-0.71) was limited to those with ≥3years' follow-up. ACEI/ARB decreased proteinuria (P < 0.001) and lowered haemoglobin (P = 0.002), but the haemoglobin change requires no additional treatment (from 119-131 g/L to 107-123 g/L). We therefore concluded that ACEI/ARB treatment may reduce patient death and graft loss, but additional well-designed prospective studies are needed to validate these findings.

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Beta and Angiotensin Blockades Are Associated With Improved 10‐Year Survival in Renal Transplant Recipients

Cited by 26 publications

References 46 publications

Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses

Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses

Beta-Blocker Use Is Associated with Higher Renal Tissue Oxygenation in Hypertensive Patients Suspected of Renal Artery Stenosis

Effect of renin‐angiotensin system inhibitors on survival in kidney transplant recipients: A systematic review and meta‐analysis

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