Long-Term Renoprotective Effect of Candesartan in Renal Transplant Patients

Ishii, Tokumi; Yasuda, Masaaki; Itami, Yoshitaka; Hayashi, Tetsuo; Uemura, Hirotsugu; Nose, Kazuhiro; Nishioka, Tsukasa

doi:10.1016/j.transproceed.2011.12.074

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…However, RAS inhibitors have potentially irreplaceable clinical significance because of their ability to improve outcomes. Many studies have investigated the possible benefits of ACEI/ARB treatment for renal transplant recipients, including the roles of controlling hypertension, reducing proteinuria and managing cardiovascular disease [1,10,11,52]. Despite this, and despite prescriptions for RAS inhibitors increasing from <20% in the early 1990s to >45% in the 2000s [19,53], there is no consensus on the benefits they offer for either patient or graft survival.…”

Section: Discussionmentioning

confidence: 99%

“…Concerning kidney transplant recipients, previous studies have confirmed that ACEI/ARB treatment is beneficial for hypertension and proteinuria [10,11], both of which are risk factors for patient death and graft loss [12]. ACEI/ARB treatment can also reduce the risk of cardiovascular events, which is the major cause of death in kidney recipients [13].…”

Section: Introductionmentioning

confidence: 97%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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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“…Estão indicados especialmente nos primeiros meses de TXR quando o risco de lesão renal aguda é maior, e os bloqueadores do SRAA, particularmente os bloqueadores dos receptores AT 1 da angiotensina II (BRA), quando a função renal estiver estável, porque essas classes farmacológicas reduzem a perda do enxerto quando comparadas às demais. No entanto, deixam claro que faltam estudos que sustentem uma recomendação baseada em evidências, já que transplantados renais são com grande frequência excluídos de ensaios clínicos randomizados comparando desfechos 4,13,56,[58][59][60][61] .…”

Section: Tratamento Não Medicamentoso Da Hipertensão Arterial No Tran...unclassified

Hipertensão arterial no transplante renal: grande importância, mas poucas respostas

Rebelo

Rodrigues

2023

Braz. J. Nephrol.

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Resumo Hipertensão arterial (HA) no póstransplante renal (TXR) se correlaciona com piores desfechos cardiovasculares e renais, com perda de função renal, diminuição da sobrevida do enxerto e maior mortalidade. Receptores de TXR apresentam valores discrepantes de pressão arterial (PA) quando ela é obtida em consultório ou por metodologias sistematizadas, como a Monitorização Ambulatorial da PA (MAPA), com prevalências significantes de ausência de descenso noturno ou hipertensão noturna, hipertensão do avental branco e hipertensão mascarada. O objetivo do presente estudo foi rever a temática da hipertensão no TXR, abordando sua fisiopatologia multifatorial e demonstrando a importância da MAPA como ferramenta de acompanhamento da PA nesses pacientes. O tratamento é baseado em mudanças no estilo de vida e em fármacos anti-hipertensivos, sendo os bloqueadores de canais de cálcio considerados de primeira linha. A melhor meta pressórica e o tratamento com desfechos mais favoráveis no TXR ainda estão por ser determinados, por meio de estudos bem conduzidos cientificamente, ou seja, em termos de HA no TXR temos atualmente mais questões a responder do que respostas a dar.

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“…They are indicated especially in the first few months of RTX when the risk of acute kidney injury is greater, and RAAS blockers, particularly angiotensin II AT1 receptor blockers (ARBs), when renal function is stable, because these drug classes reduce graft loss when compared to the others. However, they make it clear that there is a lack of studies that support an evidence-based recommendation, since kidney transplant recipients are very often excluded from randomized clinical trials comparing outcomes 4 , 13 , 56 , 58 , 59 , 60 , 61 .…”

Section: Introductionmentioning

confidence: 99%

Arterial hypertension in kidney transplantation: huge importance, but few answers

Rebelo

Rodrigues

2023

Braz. J. Nephrol.

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Arterial hypertension (AH) after renal transplantation (RTX) is correlated with worse cardiovascular and renal outcomes, with loss of renal function, decreased graft survival and higher mortality. RTX recipients have discrepant blood pressure (BP) values when measured in the office or by systematic methodologies, such as Ambulatory Blood Pressure Monitoring (ABPM), with significant prevalence of no nocturnal dipping or nocturnal hypertension, white coat hypertension and masked hypertension. The aim of the present study was to review the issue of hypertension in RTX, addressing its multifactorial pathophysiology and demonstrating the importance of ABPM as a tool for monitoring BP in these patients. Treatment is based on lifestyle changes and antihypertensive drugs, with calcium channel blockers considered first-line treatment. The best blood pressure target and treatment with more favorable outcomes in RTX are yet to be determined, through well-conducted scientific studies, that is, in terms of AH in RTX, we currently have more questions to answer than answers to give.

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Long-Term Renoprotective Effect of Candesartan in Renal Transplant Patients

Cited by 5 publications

References 9 publications

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

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

Hipertensão arterial no transplante renal: grande importância, mas poucas respostas

Arterial hypertension in kidney transplantation: huge importance, but few answers

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