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Kidney Week

Abstract: FR-PO1051

Effect of Renin-Angiotensin System Blockade on Stroke in Kidney Transplant Recipients: Retrospective Multicenter Study in Japan

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Tsuchimoto, Akihiro, Kyushu University, Fukuoka, Japan
  • Masutani, Kosuke, Fukuoka University, Fukuoka, Japan
  • Ueki, Kenji, Kyushu University, Fukuoka, Japan
  • Nakagawa, Kaneyasu, Kyushu University, Fukuoka, Japan
  • Matsukuma, Yuta, Kyushu University, Fukuoka, Japan
  • Tanaka, Shigeru, Kyushu University, Fukuoka, Japan
  • Kakuta, Yoichi, Tokyo Women's Medical University, Tokyo, Japan
  • Okumi, Masayoshi, Tokyo Women's Medical University, Shinjuku, ToKyo, Japan
  • Okabe, Yasuhiro, Kyushu University Hospital, Higashi-ku, Fukuoka, Japan
  • Nakano, Toshiaki, Kyushu University, Fukuoka, Japan
  • Kitazono, Takanari, Department of Medicine and Clinical Science, Fukuoka, Japan
  • Tanabe, Kazunari, Tokyo Women's Medical University, Shinjuku, ToKyo, Japan
Background

Renin–angiotensin system blockers (RASBs) reduce end-stage kidney disease and cardiovascular event (CVE) development in chronic kidney disease. However, whether RASBs improve long-term prognosis in kidney transplant (KT) recipients remains unknown.

Methods

We investigated 900 kidney transplant patients in a multicenter retrospective cohort study in Japan and compared death-censored graft-survival and CVE (total, cardiac events, stroke) based on RASB use within 12 months after KT. The associations were examined using a Cox hazard model and propensity score-matching analysis.

Results

The cohort comprised 375 patients treated with RASBs (RASB group) and 525 patients without RASBs (control group). The median observational period was 82 months, with 68 patients reaching graft loss: 79 total CVE, 36 cardiac events, 26 stroke. In a matching cohort comprising 582 patients, graft survival, total CVE, and cardiac events were not different between the two groups. Only stroke incidence rate was significantly lower in the RASB group compared with the control group (1.4 vs. 6.4 per 1000 patients/year, log-ranked P=0.005). In a multivariable analysis, stroke events were also significantly lower in the RASB group compared with the control group (Hazard ratio and 95% confidence interval, 0.20 [0.04–0.62]).

Conclusion

RASBs potentially reduce stroke events in KT recipients.

The cumulative incidence for each endpoint was compared between the RASB and control groups: (A) Total CVE, consisting of cardiac event, stroke, and peripheral artery disease; (B) Cardiac event; (C) Stroke; (D) Death-censored graft-survival