Department of Urology, Urology Institute and Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Urology, Urology Institute and Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Kaohsiung J Med Sci. 2018 Jan;34(1):1-13. doi: 10.1016/j.kjms.2017.07.007. Epub 2017 Aug 18.
Renin-angiotensin system inhibitors, specifically angiotensin II converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB), have confirmed renoprotective benefits in patients with proteinuria and hypertension. However, it remains controversial whether these agents are beneficial to kidney recipients. We conducted this meta-analysis to evaluate the effects of ACEI/ARB treatment on patient and allograft survival after kidney transplant. The PubMed, Embase and Cochrane Library databases were searched for eligible articles from before May 2016, and we included 24 articles (9 randomised controlled trials [RCTs] and 15 cohort studies with 54,096 patients), in which patient or graft survival was compared between an ACEI/ARB treatment arm and a control arm. Pooled results showed that ACEI/ARB was associated with decreased risks of patient death (relative risk [RR] = 0.64; 95% confidence interval [CI]:0.49-0.84) and graft loss (RR = 0.59; 95%CI:0.47-0.74). Subgroup analysis of the cohorts revealed significantly reduced patient death (RR = 0.61; 95%CI:0.50-0.74) and graft loss (RR = 0.58; 95%CI:0.46-0.73), but this was not seen in RCTs (patient survival: RR = 0.84, 95%CI:0.39-1.81; graft survival: RR = 0.70, 95%CI:0.17-2.79). Significantly less graft loss was noted among patients with biopsy-proved chronic allograft nephropathy (CAN) (RR = 0.26, 95%CI:0.16-0.44). Furthermore, the benefit of ACEI/ARB on patient survival (RR = 0.62; 95%CI:0.47-0.83) and graft survival (RR = 0.58, 95%CI:0.47-0.71) was limited to those with ≥3years' follow-up. ACEI/ARB decreased proteinuria (P < 0.001) and lowered haemoglobin (P = 0.002), but the haemoglobin change requires no additional treatment (from 119-131 g/L to 107-123 g/L). We therefore concluded that ACEI/ARB treatment may reduce patient death and graft loss, but additional well-designed prospective studies are needed to validate these findings.
肾素-血管紧张素系统抑制剂，特别是血管紧张素转换酶抑制剂（ACEI）和血管紧张素 II 受体阻滞剂（ARB），已证实可降低蛋白尿和高血压患者的肾脏保护作用。然而，这些药物对肾移植受者是否有益仍存在争议。我们进行了这项荟萃分析，以评估 ACEI/ARB 治疗对肾移植后患者和移植物存活的影响。我们在 2016 年 5 月之前在 PubMed、Embase 和 Cochrane 图书馆数据库中搜索了符合条件的文章，并纳入了 24 篇文章（9 项随机对照试验[RCT]和 15 项队列研究，共 54096 名患者），其中在 ACEI/ARB 治疗组和对照组之间比较了患者或移植物的存活情况。汇总结果表明，ACEI/ARB 可降低患者死亡（相对风险[RR]0.64；95%置信区间[CI]：0.49-0.84）和移植物丢失（RR 0.59；95%CI：0.47-0.74）的风险。对队列的亚组分析显示，患者死亡（RR 0.61；95%CI：0.50-0.74）和移植物丢失（RR 0.58；95%CI：0.46-0.73）的风险显著降低，但在 RCT 中未见此结果（患者生存：RR 0.84，95%CI：0.39-1.81；移植物生存：RR 0.70，95%CI：0.17-2.79）。在经活检证实的慢性移植肾肾病（CAN）患者中，移植物丢失明显减少（RR 0.26；95%CI：0.16-0.44）。此外，ACEI/ARB 对患者生存（RR 0.62；95%CI：0.47-0.83）和移植物生存（RR 0.58，95%CI：0.47-0.71）的益处仅限于随访时间≥3 年的患者。ACEI/ARB 可降低蛋白尿（P < 0.001）和血红蛋白（P = 0.002），但血红蛋白的变化无需额外治疗（从 119-131 g/L 降至 107-123 g/L）。因此，我们得出结论，ACEI/ARB 治疗可能降低患者死亡和移植物丢失的风险，但需要进一步进行设计良好的前瞻性研究来验证这些发现。
