Jeffrey S Zaltzman1, Michelle Nash, Rick Chiu, Ramesh Prasad. 1. Director of Renal Transplantation, Division of Nephrology, Dept of Medicine, University of Toronto, St Michael's Hospital, 30 Bond St, Toronto, Ontario, Canada M5B 1W8. jeffrey.zaltzman@utoronto.ca
Abstract
BACKGROUND: Allograft nephropathy, regardless of aetiology, leads to progressive renal injury and eventual graft loss. In native kidney disease, treatment of hypertension, in particular with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), has proven beneficial in retarding renal function decline. In the present study, we reviewed the clinical course of a renal transplant recipient cohort that was prescribed either an ACEi or ARB for biopsy-proven allograft nephropathy. METHODS: Patients were followed from the time of post-biopsy initiation of ACEi/ARB and were stratified based on biopsy findings. Outcomes of interest included safety, allograft survival, renal function and change in slope of renal function pre- and post-ACEi/ARB. RESULTS: The 5 year allograft survival after biopsy diagnosis of allograft nephropathy was 83%. Serum creatinine was 191+/-97 (86-377) micromol/l at the time of biopsy and 228+/-102 (102-575) micromol/l at last follow-up. The slopes of reciprocal creatinine vs time were used to calculate the decline in renal function and were compared pre- and post-ACEi/ARB. The mean slope+/-SD was -0.06+/-0.21 l/micromol x 10(-3) per month in the 12 months prior to therapy and -0.03+/-0.09 l/micromol x 10(-3) per month following therapy. The absolute difference in slopes was 0.03 (P =<0.0001). CONCLUSIONS: Treatment with ACEi/ARB may be beneficial in the management of allograft nephropathy.
BACKGROUND: Allograft nephropathy, regardless of aetiology, leads to progressive renal injury and eventual graft loss. In native kidney disease, treatment of hypertension, in particular with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), has proven beneficial in retarding renal function decline. In the present study, we reviewed the clinical course of a renal transplant recipient cohort that was prescribed either an ACEi or ARB for biopsy-proven allograft nephropathy. METHODS:Patients were followed from the time of post-biopsy initiation of ACEi/ARB and were stratified based on biopsy findings. Outcomes of interest included safety, allograft survival, renal function and change in slope of renal function pre- and post-ACEi/ARB. RESULTS: The 5 year allograft survival after biopsy diagnosis of allograft nephropathy was 83%. Serum creatinine was 191+/-97 (86-377) micromol/l at the time of biopsy and 228+/-102 (102-575) micromol/l at last follow-up. The slopes of reciprocal creatinine vs time were used to calculate the decline in renal function and were compared pre- and post-ACEi/ARB. The mean slope+/-SD was -0.06+/-0.21 l/micromol x 10(-3) per month in the 12 months prior to therapy and -0.03+/-0.09 l/micromol x 10(-3) per month following therapy. The absolute difference in slopes was 0.03 (P =<0.0001). CONCLUSIONS: Treatment with ACEi/ARB may be beneficial in the management of allograft nephropathy.
Authors: Ekamol Tantisattamo; Ramy M Hanna; Uttam G Reddy; Hirohito Ichii; Donald C Dafoe; Gabriel M Danovitch; Kamyar Kalantar-Zadeh Journal: Curr Opin Nephrol Hypertens Date: 2020-01 Impact factor: 3.416