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Kidney Week

Abstract: TH-PO429

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

Session Information

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
  • Ouseph, Rosemary, St Louis University, St Louis, Missouri, United States
  • Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States
  • Dharnidharka, Vikas R., Washington University School of Medicine, St Louis, Missouri, United States
  • Naik, Abhijit S., University of Michigan, Ann Arbor, Michigan, United States
  • Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada
  • Koraishy, Farrukh M., Saint Louis University, Saint Louis, Missouri, United States
  • Xiao, Huiling, St. Louis University, St. Louis, Missouri, United States
  • Zhang, Zidong, Saint Louis University, Saint Louis, Missouri, United States
  • Randall, Henry B., SSM Health/SLUH, St. Louis, Missouri, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
  • Kasiske, Bertram L., Hennepin County Medical Center, Minneapolis, Minnesota, United States
  • Hess, Gregory P., LDI University of Pennsylvania/Symphony Health, Conshohocken, Pennsylvania, United States
  • Lentine, Krista L., Saint Louis University, Saint Louis, Missouri, United States
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 1.111.241.37) and 'other' agents (aHR 1.111.241.37), but lower in those on ACEi/ARB (aHR 1.441.691.99).

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