Jung-Im Shin1, Mari Palta, Arjang Djamali, Dixon B Kaufman, Brad C Astor. 1. 1 Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI. 2 Department of Population Health Sciences, Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI. 3 Department of Medicine, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. 4 Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. 5 Department of Medicine, Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Abstract
BACKGROUND: Renin-angiotensin system (RAS) blockade reduces mortality in the general population and among non-dialysis-dependent patients with chronic kidney disease. The RAS blockade also decreases proteinuria and protects renal function in non-transplant patients with chronic kidney disease. It remains controversial, however, whether this translates to improved patient or graft survival among transplant recipients. METHODS: We analyzed 2684 primary kidney transplant recipients at the University of Wisconsin in 1994 to 2010 who had a functioning graft at 6 months after transplantation. We assessed the association of RAS blockade with patient and graft survival using time-dependent Cox and marginal structural models. RESULTS: Three hundred seventy-seven deaths and 329 graft failures before death (638 total graft losses) occurred during a median of 5.4 years of follow-up. The RAS blockade was associated with an adjusted-hazard ratio of 0.63 (95% confidence interval, 0.53-0.75) for total graft loss, 0.69 (0.55-0.86) for death, and 0.62 (0.49-0.78) for death-censored graft failure. The associations of RAS blockade with a lower risk of total graft loss and mortality were stronger with more severe proteinuria. The RAS blockade was associated with a 2-fold higher risk of hyperkalemia. CONCLUSIONS: Our findings suggest RAS blockade is associated with better patient and graft survival in renal transplant recipients.
BACKGROUND: Renin-angiotensin system (RAS) blockade reduces mortality in the general population and among non-dialysis-dependent patients with chronic kidney disease. The RAS blockade also decreases proteinuria and protects renal function in non-transplant patients with chronic kidney disease. It remains controversial, however, whether this translates to improved patient or graft survival among transplant recipients. METHODS: We analyzed 2684 primary kidney transplant recipients at the University of Wisconsin in 1994 to 2010 who had a functioning graft at 6 months after transplantation. We assessed the association of RAS blockade with patient and graft survival using time-dependent Cox and marginal structural models. RESULTS: Three hundred seventy-seven deaths and 329 graft failures before death (638 total graft losses) occurred during a median of 5.4 years of follow-up. The RAS blockade was associated with an adjusted-hazard ratio of 0.63 (95% confidence interval, 0.53-0.75) for total graft loss, 0.69 (0.55-0.86) for death, and 0.62 (0.49-0.78) for death-censored graft failure. The associations of RAS blockade with a lower risk of total graft loss and mortality were stronger with more severe proteinuria. The RAS blockade was associated with a 2-fold higher risk of hyperkalemia. CONCLUSIONS: Our findings suggest RAS blockade is associated with better patient and graft survival in renal transplant recipients.
Authors: Marlies Antlanger; Oliver Domenig; Johannes J Kovarik; Christopher C Kaltenecker; Chantal Kopecky; Marko Poglitsch; Marcus D Säemann Journal: J Renin Angiotensin Aldosterone Syst Date: 2017 Apr-Jun Impact factor: 1.636