Skip to main content

Advertisement

SpringerLink
Log in

Effect of pre-transplantation use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in kidney transplant recipients—propensity score-matched analysis

  • Original Article
  • Published:
Journal of Nephrology Aims and scope Submit manuscript

Abstract

Background

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEi/ARBs) can cause acute kidney injury under dehydratation or in hemodynamically unstable conditions. Regarding kidney transplantation (KT), the risk of using ACEi/ARBs before surgery is not well established. Therefore, we evaluated the clinical outcomes to determine the effect of preoperative use of ACEi/ARBs on KT.

Methods

We retrospectively collected 1187 patients who received living-donor KT between January 2017 and December 2021. We conducted a propensity score-matched analysis between the ACEi/ARB(+) and ACEi/ARB(–) groups and evaluated the effects of ACEi/ARBs on delayed graft function, post-KT renal function, hyperkalemia events, rejection, and graft survival.

Results

The ACEi/ARB(+) group showed a similar incidence of delayed graft function as the ACEi/ARB(–) group (1.8% vs. 1.0%, P = 0.362). The risk of delayed graft function was not upregulated in the ACEi/ARB(+) group after propensity score-matching (odds ratio: 0.50, 95% confidence interval (CI) 0.13–2.00). Postoperative creatinine levels and the slope of creatinine levels after KT also were not significantly different between the two groups (creatinine slope from POD#0 to POD#7: – 0.73 ± 0.35 vs. – 0.75 ± 0.32 mg/dL/day, P = 0.464). Hyperkalemia did not occur more often in the ACEi/ARB(+) group than in the ACEi/ARB(–) group during perioperative days. Rejection-free survival (P = 0.920) and graft survival (P = 0.621) were not significantly different between the two groups.

Conclusions

In KT, the preoperative use of ACEi/ARBs did not significantly affect clinical outcomes including delayed graft function, postoperative renal function, hyperkalemia events, incidence of rejection, and graft survival rates compared to the patients who did not receive ACEi/ARBs.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The data supporting this study’s findings are available from the corresponding author upon reasonable request.

Abbreviations

ACEi:

Angiotensin-converting enzyme inhibitor

ARBs:

Angiotensin receptor blockers

BMI:

Body mass index

CI:

Confidence interval

HLA:

Human leukocyte antigen

HR:

Hazard ratio

IV:

Intravenous

KT:

Kidney transplantation

References

  1. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, Ramirez A, Schlaich M, Stergiou GS, Tomaszewski M et al (2020) 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens 38:982–1004. https://doi.org/10.1097/HJH.0000000000002453

    Article  CAS  PubMed  Google Scholar 

  2. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A et al (2018) 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 39:3021–3104. https://doi.org/10.1093/eurheartj/ehy339

    Article  PubMed  Google Scholar 

  3. Stevens PE, Levin A, Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members (2013) Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 158:825–830. https://doi.org/10.7326/0003-4819-158-11-201306040-00007

    Article  PubMed  Google Scholar 

  4. Feidakis A, Panagiotou MR, Tsoukakis E, Bacharaki D, Gounari P, Nikolopoulos P, Marathias KP, Lionaki S, Vlahakos D (2021) Impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on acute kidney injury in emergency medical admissions. J Clin Med 10:412. https://doi.org/10.3390/jcm10030412

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Tomson C, Tomlinson LA (2019) Stopping RAS inhibitors to minimize AKI: more harm than good? Clin J Am Soc Nephrol 14:617–619. https://doi.org/10.2215/CJN.14021118

    Article  PubMed  PubMed Central  Google Scholar 

  6. Arora P, Rajagopalam S, Ranjan R, Kolli H, Singh M, Venuto R, Lohr J (2008) Preoperative use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers is associated with increased risk for acute kidney injury after cardiovascular surgery. Clin J Am Soc Nephrol 3:1266–1273. https://doi.org/10.2215/CJN.05271107

    Article  PubMed  PubMed Central  Google Scholar 

  7. Thakar CV, Kharat V, Blanck S, Leonard AC (2007) Acute kidney injury after gastric bypass surgery. Clin J Am Soc Nephrol 2:426–430. https://doi.org/10.2215/CJN.03961106

    Article  PubMed  Google Scholar 

  8. Coca SG, Garg AX, Swaminathan M, Garwood S, Hong K, Thiessen-Philbrook H, Passik C, Koyner JL, Parikh CR, Tribe-Aki Consortium (2013) Preoperative angiotensin-converting enzyme inhibitors and angiotensin receptor blocker use and acute kidney injury in patients undergoing cardiac surgery. Nephrol Dial Transplant 28:2787–2799. https://doi.org/10.1093/ndt/gft405

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. STARSurg Collaborative (2018) Association between peri-operative angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers and acute kidney injury in major elective non-cardiac surgery: a multicentre, prospective cohort study. Anaesthesia 73:1214–1222. https://doi.org/10.1111/anae.14349

    Article  CAS  Google Scholar 

  10. van Diepen S, Norris CM, Zheng Y, Nagendran J, Graham MM, Gaete Ortega D, Townsend DR, Ezekowitz JA, Bagshaw SM (2018) Comparison of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker management strategies before cardiac surgery: a pilot randomized controlled registry trial. J Am Heart Assoc 7:e009917. https://doi.org/10.1161/JAHA.118.009917

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bonavia A, Javaherian M, Skojec AJ, Chinchilli VM, Mets B, Karamchandani K (2019) Angiotensin axis blockade, acute kidney injury, and perioperative morbidity in patients undergoing colorectal surgery: a retrospective cohort study. Medicine (Baltimore) 98:e16872. https://doi.org/10.1097/MD.0000000000016872

    Article  CAS  PubMed  Google Scholar 

  12. Lim MA, Bloom RD (2020) Medical therapies to reduce delayed graft function and improve long-term graft survival: are we making progress? Clin J Am Soc Nephrol 15:13–15. https://doi.org/10.2215/CJN.13961119

    Article  PubMed  Google Scholar 

  13. Mannon RB (2018) Delayed graft function: the AKI of kidney transplantation. Nephron 140:94–98. https://doi.org/10.1159/000491558

    Article  PubMed  Google Scholar 

  14. Hoorn EJ, Walsh SB, McCormick JA, Zietse R, Unwin RJ, Ellison DH (2012) Pathogenesis of calcineurin inhibitor-induced hypertension. J Nephrol 25:269–275. https://doi.org/10.5301/jn.5000174

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Heinze G, Mitterbauer C, Regele H, Kramar R, Winkelmayer WC, Curhan GC, Oberbauer R (2006) Angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor antagonist therapy is associated with prolonged patient and graft survival after renal transplantation. J Am Soc Nephrol 17:889–899. https://doi.org/10.1681/ASN.2005090955

    Article  CAS  PubMed  Google Scholar 

  16. Hernandez D, Muriel A, Abraira V, Perez G, Porrini E, Marrero D, Zamora J, Gonzalez-Posada JM, Delgado P, Rufino M, Torres A (2012) Renin-angiotensin system blockade and kidney transplantation: a longitudinal cohort study. Nephrol Dial Transplant 27:417–422. https://doi.org/10.1093/ndt/gfr276

    Article  CAS  PubMed  Google Scholar 

  17. Formica RN Jr, Friedman AL, Lorber MI, Smith JD, Eisen T, Bia MJ (2006) A randomized trial comparing losartan with amlodipine as initial therapy for hypertension in the early post-transplant period. Nephrol Dial Transplant 21:1389–1394. https://doi.org/10.1093/ndt/gfk058

    Article  CAS  PubMed  Google Scholar 

  18. Stevens KK, Patel RK, Clancy M, Jardine AG (2010) Angiotensin blockade is associated with early graft dysfunction after live donor renal transplantation. Transplantation 89:707–709. https://doi.org/10.1097/TP.0b013e3181c892f2

    Article  CAS  PubMed  Google Scholar 

  19. Israili ZH (2000) Clinical pharmacokinetics of angiotensin II (AT1) receptor blockers in hypertension. J Hum Hypertens 14(Suppl 1):S73-86. https://doi.org/10.1038/sj.jhh.1000991

    Article  CAS  PubMed  Google Scholar 

  20. Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. https://doi.org/10.1016/j.jclinepi.2007.11.008

Download references

Acknowledgements

The authors would like to thank Hyojin Lee for coordinating kidney transplantation in our medical center.

Funding

This study was supported by a grant (2021IF0019) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Jaeyun Lee, Chan-Young Jung, Hyosang Kim, Su-Kil Park & Chung Hee Baek

  2. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Hwa Jung Kim

  3. Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Youngmin Ko, Hyunwook Kwon, Sung Shin & Young Hoon Kim

Authors
  1. Jaeyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chan-Young Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyosang Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hwa Jung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Youngmin Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyunwook Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sung Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Young Hoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Su-Kil Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chung Hee Baek
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Participated in the research design: Jaeyun Lee, Chung Hee Baek. Participated in the writing of the paper: Jaeyun Lee, Chung Hee Baek. Participated in the execution of the research: Chan-Young Jung, Hyosang Kim, Youngmin Ko, Hyunwook Kwon, Sung Shin, Young Hoon Kim, Su-Kil Park. Participated in data analysis: Hwa Jung Kim, Jaeyun Lee, Chung Hee Baek. Participated in data interpretation: Jaeyun Lee, Chung Hee Baek, Chan-Young Jung, Hyosang Kim, Youngmin Ko, Hyunwook Kwon, Sung Shin, Young Hoon Kim, Su-Kil Park, Hwa Jung Kim.

Corresponding author

Correspondence to Chung Hee Baek.

Ethics declarations

Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

This study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Asan Medical Center Institutional Review Board (Number: 2023–1276).

Consent to participate

The study protocol and waiver of consent were approved by the Asan Medical Center Institutional Review Board (2023–1276). All data used in this study were anonymized.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 42 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J., Jung, CY., Kim, H. et al. Effect of pre-transplantation use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in kidney transplant recipients—propensity score-matched analysis. J Nephrol (2024). https://doi.org/10.1007/s40620-024-01938-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40620-024-01938-3

Keywords

Search

Navigation