title: Specific management of anemia and hypertension in renal transplant recipients: influence of renin-angiotensin system blockade.
abstract: BACKGROUND
  Renin-angiotensin system (RAS) inhibition has proven to be helpful in reducing cardiovascular and kidney disease progression in the general population; whether kidney transplant patients would derive similar benefits is unknown. RAS inhibition also reduces posttransplantation erythrocytosis in kidney transplant recipients, but its effect on hemoglobin (Hb) levels in patients without posttransplantation erythrocytosis is unclear.
  
  
  METHODS
  The Specific Management of Anemia and Hypertension in Renal Transplant (SMAhRT) recipients study was designed to examine the cardiovascular benefits of RAS blockade with telmisartan 80 mg versus placebo, and Hb management with darbepoetin α in a randomized, double-blind, single-center controlled trial in 2,000 patients over 3 years. The primary efficacy variable was a composite of all-cause mortality, myocardial infarction or stroke.
  
  
  RESULTS
  The SMAhRT study was stopped prematurely due to a lower than expected event rate. At that point, 136 patients were enrolled and were followed for a mean duration of 15 months. The use of RAS blockade was not associated with an increased risk of adverse events such as worsening anemia or hyperkalemia. Likewise, the correction of Hb with darbepoetin was not associated with any increase in thrombotic events.
  
  
  CONCLUSIONS
  This study provides insight into the safety of RAS inhibition and Hb correction with an erythrocyte-stimulating agent in kidney transplant recipients.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Md., USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Salzberg
authors.forename: Feras F
authors.initials: FF
authors.lastname: Karadsheh
authors.forename: Abdolreza
authors.initials: A
authors.lastname: Haririan
authors.forename: Venkata
authors.initials: V
authors.lastname: Reddivari
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications* / Q000628:therapy*; D001562:Benzimidazoles / Q000008:administration & dosage; D001565:Benzoates / Q000008:administration & dosage; D000068256:Darbepoetin alfa; D004311:Double-Blind Method; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006454:Hemoglobins / Q000737:chemistry; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D012084:Renin-Angiotensin System / Q000187:drug effects*; D020521:Stroke / Q000150:complications; D000077333:Telmisartan; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001562:Benzimidazoles; D001565:Benzoates; D006454:Hemoglobins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000077333:Telmisartan