TY - JOUR
T1 - Effect of renin–angiotensin system blockade on graft survival and cardiovascular disease in kidney transplant recipients
T2 - retrospective multicenter study in Japan
AU - the Japan Academic Consortium of Kidney Transplantation (JACK) Investigators
AU - Tsuchimoto, Akihiro
AU - Masutani, Kosuke
AU - Ueki, Kenji
AU - Nakagawa, Kaneyasu
AU - Matsukuma, Yuta
AU - Tanaka, Shigeru
AU - Unagami, Kohei
AU - Kakuta, Yoichi
AU - Okumi, Masayoshi
AU - Noguchi, Hiroshi
AU - Kaku, Keizo
AU - Okabe, Yasuhiro
AU - Nakano, Toshiaki
AU - Kitazono, Takanari
AU - Nakamura, Masafumi
AU - Ishida, Hideki
AU - Tanabe, Kazunari
N1 - Funding Information:
We thank Edanz Group (www.edanzediting.com/ac ) for editing a draft of this manuscript. We appreciate the support from Katsunori Shimada, PhD (STATZ Institute, Inc., Tokyo, Japan), who provided expert assistance with data management. JACK Participating Centers: Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan: Investigators Kazunari Tanabe, Masayoshi Okumi, Yoichi Kakuta, and Daisuke Toki. Department of Organ Transplant Medicine, Tokyo Women’s Medical University, Tokyo, Japan: Investigators Hideki Ishida and Kohei Unagami. Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital: Investigators Hiroshi Toma, Tomokazu Shimizu and Kazuya Omoto. Department of Urology, Ohkubo Hospital: Investigator Hiroki Shirakawa. Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan: Investigators Yasuhiro Okabe, Atsuchi Doi, Keizo Kaku, and Koji Noguchi. Department of Surgery Tomishiro Central Hospital, Okinawa: Investigator Ota Morihito. JACK Data Center: Katsunori Shimada, Department of Biostatistics, STATZ Institute, Inc., Tokyo, Japan. JACK General Management Office: Masayoshi Okumi, Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan.
Publisher Copyright:
© 2019, Japanese Society of Nephrology.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: Renin–angiotensin system blockers (RASBs) reduce end-stage kidney disease and cardiovascular event (CVE) development in chronic kidney disease. However, whether RASBs improve long-term prognosis in kidney transplant (KT) recipients remain unknown. Method: We investigated 900 kidney transplant patients in a multicenter retrospective cohort study in Japan and compared death-censored graft survival and CVE (total, cardiac events, stroke) based on RASB use within 12 months after KT. The associations were examined using a Cox hazard model and propensity score-matching analysis. Results: The cohort comprised 375 patients treated with RASBs (RASB group) and 525 patients without RASBs (control group). The median observational period was 82 months, with 68 patients reaching graft loss: 79 total CVE, 36 cardiac events, 26 stroke. In a matching cohort comprising 582 patients, death-censored graft survival, total CVE, and cardiac events were not different between the two groups. Only stroke incidence rate was significantly lower in the RASB group compared with the control group (1.4 vs. 6.4 per 1000 patients/year, log-ranked P = 0.005). In a multivariable analysis, stroke events were also significantly lower in the RASB group compared with the control group (Hazard ratio and 95% confidence interval, 0.20 [0.04–0.62]). Conclusion: Thus, RASBs potentially reduce stroke events in KT recipients.
AB - Background: Renin–angiotensin system blockers (RASBs) reduce end-stage kidney disease and cardiovascular event (CVE) development in chronic kidney disease. However, whether RASBs improve long-term prognosis in kidney transplant (KT) recipients remain unknown. Method: We investigated 900 kidney transplant patients in a multicenter retrospective cohort study in Japan and compared death-censored graft survival and CVE (total, cardiac events, stroke) based on RASB use within 12 months after KT. The associations were examined using a Cox hazard model and propensity score-matching analysis. Results: The cohort comprised 375 patients treated with RASBs (RASB group) and 525 patients without RASBs (control group). The median observational period was 82 months, with 68 patients reaching graft loss: 79 total CVE, 36 cardiac events, 26 stroke. In a matching cohort comprising 582 patients, death-censored graft survival, total CVE, and cardiac events were not different between the two groups. Only stroke incidence rate was significantly lower in the RASB group compared with the control group (1.4 vs. 6.4 per 1000 patients/year, log-ranked P = 0.005). In a multivariable analysis, stroke events were also significantly lower in the RASB group compared with the control group (Hazard ratio and 95% confidence interval, 0.20 [0.04–0.62]). Conclusion: Thus, RASBs potentially reduce stroke events in KT recipients.
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U2 - 10.1007/s10157-019-01827-1
DO - 10.1007/s10157-019-01827-1
M3 - Article
C2 - 31875930
AN - SCOPUS:85077140679
SN - 1342-1751
VL - 24
SP - 369
EP - 378
JO - Clinical and Experimental Nephrology
JF - Clinical and Experimental Nephrology
IS - 4
ER -
