Aim: A strong pathophysiological rationale underpins the use of RAAS blockers in renal transplant recipients. Nevertheless, transplant physicians are reluctant to use these drugs, due to the risk of renal function decline and hyperkalemia. The aim of this study was to investigate the antihypertensive efficacy and safety of RAAS blockers in the very early postoperative period after renal transplantation.
Methods: We analyzed the medical charts of patients transplanted at our centre during the past 8 years. 147 kidney transplant recipients were treated with a RAAS blocker due to uncontrolled hypertension. 115 kidney transplant patients who did not receive a RAAS blocker during their hospital stay were used as controls. Cases and controls were matched by age, sex, year of transplantation and serum creatinine at the time of administration of the RAAS blocker. Blood pressure, serum creatinine, eGFR (by means of the CKD-EPI equation) and serum potassium levels where compared between the two groups.
Results: 119 (80.4%) patients were treated with an ACE Inhibitor and 28(18.9%) with an ARB. Most patients received the RAAS blocker at postoperative day 8 and were discharged at postoperative day 13. There were no significant differences in baseline clinical demographic characteristics, immunological risk factors, immunosuppression levels, concomitant medication, renal function and potassium levels between cases and controls, except for blood pressure. Systolic, diastolic and mean blood pressure at treatment initiation were increased in the RAAS blocker group (150 ± 17 vs. 141 ± 16, 86 ± 12 vs. 81 ± 11 and 108 ± 11 vs. 101 ± 11mmHg, p<0.001 for all variables). At discharge, blood pressure control was comparable in both groups (138 ± 21 vs. 130 ± 19, 79 ± 10 vs. 79 ± 12 and 98 ± 12 vs. 95 ±14mmHg, p=ns for all variables) and this was achieved without differences in renal function and potassium levels (53 ± 12 vs. 61 ± 8ml/min, p=0.33 for eGFR and 4.85 ± 0.48 vs. 4.77 ± 0.25¯o;mol/l, p=0.77 for potassium).
Conclusion: RAAS blockers can effectively reduce blood pressure in the early postoperative period after kidney transplantation, without jeopardizing graft function and without increasing the risk of hyperkalemia.
To cite this abstract in AMA style:Chatzikyrkou C, Eichler J, Clajus C, Menne J, Lehner F, Helfriz F, Kousoulas L, Ramackers W, Haller H, Schiffer M. Efficacy and Safety of Renin Angiotensin Aldosterone System (RAAS) Blockade Immediately after Renal Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/efficacy-and-safety-of-renin-angiotensin-aldosterone-system-raas-blockade-immediately-after-renal-transplantation/. Accessed March 31, 2020.
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