Skip Navigation



NDT Advance Access published online on October 5, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh462
© 2004 by European Renal Association - European Dialysis and Transplant Association
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
19/11/2852    most recent
gfh462v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Artz, M. A.
Right arrow Articles by Wetzels, J. F. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Artz, M. A.
Right arrow Articles by Wetzels, J. F. M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Received February 27, 2004
Accepted July 19, 2004

Original Articles

Blockade of the renin-angiotensin system increases graft survival in patients with chronic allograft nephropathy

Marika A. Artz 1*, Luuk B. Hilbrands 1, George Borm 2, Karel J. M. Assmann 3, and Jack F. M. Wetzels 1

1 Department of Nephrology, University Medical Center St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands
2 Department of Epidemiology and Biostatistics, University Medical Center St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands
3 Department of Pathology, University Medical Center St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands

* To whom correspondence should be addressed. E-mail: m.artz{at}nier.umcn.nl.



  Abstract

Background. Chronic allograft nephropathy (CAN) is the leading cause of late allograft failure, with only limited treatment options. Blockade of the renin-angiotensin system (RAS) decreases progression in diabetic and non-diabetic renal disease, but the effect on CAN is as yet unclear. Therefore, we have studied retrospectively the effect of RAS blockade on renal survival in patients with biopsy-proven CAN.

Methods. The medical records of 72 patients with biopsy-proven CAN were evaluated with regard to time course of graft function, proteinuria, blood pressure, and antihypertensive and immunosuppressive treatment. Cox's proportional hazards model was used for analysing renal graft survival after the index biopsy.

Results. On univariate analysis, histological determinants influencing renal survival were the chronic interstitial and chronic tubular score, and clinical parameters were the serum creatinine level at the time of the biopsy, the relative change in serum creatinine level between 12 months post-transplantation and at the time of the biopsy, mean systolic and diastolic blood pressure after the biopsy, and RAS blockade by angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. On multivariate analysis, graft outcome was influenced by the relative change in serum creatinine level between 12 months post-transplantation and the time of the index biopsy, the urinary protein excretion, the mean diastolic blood pressure after the index biopsy, and RAS blockade. Renal graft survival after treatment with RAS blockade was 6.3 (0.9-10.9) years as opposed to 1.8 (0.1-6.7) years in untreated patients (P = 0.003).

Conclusion. RAS blockade increases graft survival in CAN. In view of the limited treatment options for CAN, this finding is of importance and needs confirmation by a prospective randomized trial.

Keywords: chronic allograft nephropathy; prognosis; renal transplantation; renin-angiotensin system.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J. Am. Soc. Nephrol.Home page
R. D. Bloom and P. P. Reese
Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation
J. Am. Soc. Nephrol., December 1, 2007; 18(12): 3031 - 3041.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
A. E. Courtney, P. T. McNamee, W. E. Nelson, and A. P. Maxwell
Does angiotensin blockade influence graft outcome in renal transplant recipients with IgA nephropathy?
Nephrol. Dial. Transplant., December 1, 2006; 21(12): 3550 - 3554.
[Abstract] [Full Text] [PDF]

Home page
 CJASNHome page
A. Djamali, M. Samaniego, B. Muth, R. Muehrer, R. M. Hofmann, J. Pirsch, A. Howard, G. Mourad, and B. N. Becker
Medical Care of Kidney Transplant Recipients after the First Posttransplant Year
Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 623 - 640.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
R. N. Formica Jr, A. L. Friedman, M. I. Lorber, J. D. Smith, T. Eisen, and M. J. Bia
A randomized trial comparing losartan with amlodipine as initial therapy for hypertension in the early post-transplant period
Nephrol. Dial. Transplant., May 1, 2006; 21(5): 1389 - 1394.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
G. Heinze, C. Mitterbauer, H. Regele, R. Kramar, W. C. Winkelmayer, G. C. Curhan, and R. Oberbauer
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., March 1, 2006; 17(3): 889 - 899.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.