Early use of renin–angiotensin–aldosterone system inhibitors after renal transplantation

Christophe Mariat

This article has no abstract so we have provided the first paragraph of the full text.

The literature review conducted by Jennings and Taber found only weak clinical evidence to support initiation of renin–angiotensin–aldosterone system (RAAS) blockade within the first 3 months after renal transplantation. Just three of the seven studies identified were randomized controlled trials (RCTs). One of the RCTs found no difference in GFR after 2 weeks between patients randomized to receive the ACEI lisinopril and those randomized to receive the calcium-channel blocker nifedipine, both of which were initiated very early (mean 3 days for lisinopril) after transplantation. Two other RCTs that investigated the efficacy of the early use of ACEIs in kidney transplant recipients with hypertension and stable renal function reported that, after 2 years of treatment, the ACEI quinapril was superior to the -blocker atenolol in terms of reductions in left ventricular hypertrophy and proteinuria. Importantly, none of these RCTs directly compared different timings of ACEI initiation. Thus, while the early administration of RAAS blockers after renal transplantation might be safe, the possibility that the beneficial effects of these agents on left ventricular hypertrophy and proteinuria would be the same even if their introduction was delayed cannot be ruled out.

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