Systematic review of ARB and ACE inhibitor use in kidney transplant recipients
Original article
Hiremath S et al. (2007) Renin angiotensin system blockade in kidney transplantation: a systematic review of the evidence. Am J Transplant 7: 2350–2360 PubMed
Routine use of angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) is recommended in proteinuric nontransplant kidney disease patients, to reduce proteinuria and slow progression of chronic kidney disease. Data on use of these drugs in kidney transplant recipients, however, are limited. A recent systematic review analyzed data from 21 randomized controlled trials of ACE inhibitors or ARBs involving 1,549 kidney transplant recipients.
Pooled analyses showed that use of an ACE inhibitor and/or an ARB was associated with a greater decrease in glomerular filtration rate (GFR) than were control management strategies (weighted mean difference [WMD] -5.7 ml/min, 95% CI -8.7 to -2.8; P <0.001). Baseline GFR, duration of follow-up and time after transplantation did not influence the change in GFR. When analyses were restricted to studies with at least 12 months of follow-up, use of an ACE inhibitor and/or an ARB was associated with a significantly greater decline in proteinuria than were control strategies (WMD -0.47 g/day, 95% CI -0.86 to -0.08; P = 0.02), but there was no difference in the degree to which potassium level changed. Use of either drug was associated with a greater decline in hematocrit than were control strategies (WMD -3.5%, 95% CI -6.1 to -0.95; P = 0.007). Mean arterial blood pressure changes in patients on ACE inhibitors or ARBs were similar to those in controls.
Clinicians should consider the benefits and risks of ACE inhibitors and ARBs before prescribing them to renal transplant recipients.
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Subject areas under which this article appears: Transplant
