title: Renin-angiotensin system blockade and kidney transplantation: a longitudinal cohort study.
abstract: BACKGROUND
  The beneficial effect of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) in kidney transplant recipients on modern immunosuppression is not yet well established. Our objective was to investigate the impact of the use of ACEI/ARB on patient and graft survival in a cohort of kidney transplant recipients.
  
  
  METHODS
  A total of 990 patients, who received a single deceased donor kidney at our institution between 1996 and 2005, were included in this longitudinal cohort study. All-cause mortality and death-censored graft loss were the primary outcomes. We used traditional time-dependent Cox model (unweighted) and inverse-probability-of-treatment weighting of marginal structural models (weighted Cox model), controlling for time-dependent confounding by indication.
  
  
  RESULTS
  A total of 414 patients (42%) received ACEI/ARB through the study period (median duration 14 months, interquartile range 6-40 months). ACEI/ARB use was associated with reduction of risk for mortality in the crude [hazard ratio (HR) 0.627, 95% confidence interval (CI) 0.412-0.953] and adjusted Cox analysis (HR 0.626, 95% CI 0.407-0.963). Similar results were observed after adjusting for confounding by indication (HR 0.629, 95% CI 0.407-0.973). By contrast, ACEI/ARB use was not associated with significant improvement of graft survival after kidney transplantation.
  
  
  CONCLUSIONS
  ACEI/ARB prescription may be suggested as beneficial among multiple medications for reducing mortality in kidney transplant recipients, but its use was not associated with longer graft survival.
authors.affiliation: Nephrology Department, Hospital Regional Universitario Carlos Haya, Málaga, Spain. domingohernandez@gmail.com
authors.forename: Domingo
authors.initials: D
authors.lastname: Hernández
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.forename: Víctor
authors.initials: V
authors.lastname: Abraira
authors.forename: Germán
authors.initials: G
authors.lastname: Pérez
authors.forename: Esteban
authors.initials: E
authors.lastname: Porrini
authors.forename: Domingo
authors.initials: D
authors.lastname: Marrero
authors.forename: Javier
authors.initials: J
authors.lastname: Zamora
authors.forename: José Manuel
authors.initials: JM
authors.lastname: González-Posada
authors.forename: Patricia
authors.initials: P
authors.lastname: Delgado
authors.forename: Margarita
authors.initials: M
authors.lastname: Rufino
authors.forename: Armando
authors.initials: A
authors.lastname: Torres
mesh_terms: D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016030:Kidney Transplantation / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012084:Renin-Angiotensin System / Q000187:drug effects*; D015996:Survival Rate
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors