The Effect of Renin-angiotensin System Inhibitors on Kidney Allograft Survival: A Systematic Review and Meta-analysis.

Wisit Cheungpasitporn, Charat Thongprayoon, Michael A Mao, Wonngarm Kittanamongkolchai, Insara J J Sathick, Stephen B Erickson
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引用次数: 16

Abstract

Background: The use of renin-angiotensin system (RAS) inhibitors in patients with chronic kidney disease, and especially in diabetic kidney disease, has been shown to provide renoprotective effects and slow progression to end-stage renal disease. However, this protective effect in kidney transplant patient populations is unclear.

Aim: The objective of this systematic review and meta-analysis was to evaluate the effect of RAS inhibitors on kidney allograft survival.

Materials and methods: A literature search for randomized controlled trials (RCTs) was performed from inception through February 2016. Studies that reported relative risks or hazard ratios comparing the risks of renal graft loss in renal transplant recipients who received RAS inhibitors vs. controls were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method.

Results: Five studies (3 RCTs and 2 cohort studies) with 20024 kidney transplant patients were included in the meta-analysis. Pooled RR of allograft failure in recipients who received RAS inhibitors was 0.73 (95% CI: 0.45-1.21). When meta-analysis was limited only to RCTs, the pooled RR of allograft failure in patients using RAS inhibitors was 0.59 (95%: CI 0.20-1.69). The risk for mortality (RR: 1.13 [95% CI: 0.62-2.07]) in patients using RAS inhibitors compared to controls was not significantly reduced.

Conclusion: This meta-analysis demonstrated insignificant reduced risks of renal graft loss among renal transplant recipients who received RAS inhibitors. Future studies assessing the potential benefits of RAS inhibitors on allograft survival in specific kidney transplant patient populations are needed.

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肾素-血管紧张素系统抑制剂对同种异体肾移植存活的影响:一项系统回顾和荟萃分析。
研究背景:肾素-血管紧张素系统(RAS)抑制剂在慢性肾病患者,尤其是糖尿病肾病患者中的应用,已被证明可提供肾脏保护作用,并减缓终末期肾病的进展。然而,这种保护作用在肾移植患者群体中尚不清楚。目的:本系统综述和荟萃分析的目的是评估RAS抑制剂对同种异体肾移植生存的影响。材料和方法:从开始到2016年2月,对随机对照试验(rct)进行文献检索。研究报告了相对风险或风险比,比较了接受RAS抑制剂的肾移植受者与对照组的肾移植损失风险。合并风险比(rr)和95%置信区间(ci)采用随机效应、通用逆方差法计算。结果:5项研究(3项随机对照试验和2项队列研究)纳入了20024例肾移植患者。接受RAS抑制剂的受体移植失败的合并RR为0.73 (95% CI: 0.45-1.21)。当荟萃分析仅限于rct时,使用RAS抑制剂的患者的同种异体移植失败的总RR为0.59 (95%:CI 0.20-1.69)。与对照组相比,使用RAS抑制剂的患者死亡风险(RR: 1.13 [95% CI: 0.62-2.07])没有显著降低。结论:本荟萃分析显示,接受RAS抑制剂治疗的肾移植受者肾移植损失风险降低不显著。未来的研究需要评估RAS抑制剂对特定肾移植患者群体的同种异体移植存活的潜在益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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