Kidney Week

Abstract: TH-PO429

Variation in Use of Antihypertensive Medications After Kidney Transplant and Associated Outcomes: A National Study

Session Information

• Hypertension and CVD: Epidemiology, Risk Factors, Prevention
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

• Yamout, Hala, VA St. Louis HealthCare System, Saint Louis, Missouri, United States

Hala Yamout,

• Ouseph, Rosemary, St Louis University, St Louis, Missouri, United States

Rosemary Ouseph,

• Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States

Mark Schnitzler,

• Dharnidharka, Vikas R., Washington University School of Medicine, St Louis, Missouri, United States

Vikas R. Dharnidharka,

• Naik, Abhijit S., University of Michigan, Ann Arbor, Michigan, United States

Abhijit S. Naik,

• Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada

Ngan Lam,

• Koraishy, Farrukh M., Saint Louis University, Saint Louis, Missouri, United States

Farrukh M. Koraishy,

• Xiao, Huiling, St. Louis University, St. Louis, Missouri, United States

Huiling Xiao,

• Zhang, Zidong, Saint Louis University, Saint Louis, Missouri, United States

Zidong Zhang,

• Randall, Henry B., SSM Health/SLUH, St. Louis, Missouri, United States

Henry B. Randall,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

• Kasiske, Bertram L., Hennepin County Medical Center, Minneapolis, Minnesota, United States

Bertram L. Kasiske,

• Hess, Gregory P., LDI University of Pennsylvania/Symphony Health, Conshohocken, Pennsylvania, United States

Gregory P. Hess,

• Lentine, Krista L., Saint Louis University, Saint Louis, Missouri, United States

Krista L. Lentine,

Background

Hypertension is a common comorbidity in kidney transplant (KTx) recipients. Impact of antihypertensive medication (AHM) regimen on patient and graft outcomes is not clear.

Methods

A novel database linking SRTR registry data for 54,153 KTx recipients with AHM fill records from a large pharmaceutical claims warehouse (2008-2015) was used. Mutually exclusive regimens were defined hierarchically as based in: Angiotensin converting enzyme inhibitor/angiotensin receptor blockers (ACEi/ARB), dihydropyridine calcium channel blockers (DHP-CCB), beta blockers (BB) and vasodilators/others. Associations (adjusted hazard ratio, _{95% LCL} aHR _{95% UCL}) of AHM regimen 7-12 months post-transplant with patient and graft survival over 5 years were quantified by multivariate Cox regression with adjustment for recipient, donor and transplant factors, and clustering for center.

Results

The most common AHM post-transplant was DHP-CCB, followed by BB, ACEi/ARB, and diuretics. Regimen patterns varied by transplant centers (Fig 1). In bi-level hierarchical modeling, compared to DHP-CCB-based treatment, ACEi/ARB use was more common in those with diabetes, obesity, and mTORi-based immunosuppression. Unadjusted survival varied with AHM treatment (Fig 2). Compared to DHP-CCB reference, adjusted mortality was higher in those on NDHP-CCB (aHR _1.111.24_1.37) and 'other' agents (aHR _1.111.24_1.37), but lower in those on ACEi/ARB (aHR _1.441.69_1.99).

Conclusion

While associations may in part reflect unobserved selection factors, controlled studies are needed to determine optimal AHM regimens after KTx, reduce unjustified practice variation, and inform evidence-based best practices.

Funding

• NIDDK Support