RAS Blockade Discontinuation among Kidney Transplant Recipients

Recipients of kidney transplantation commonly experience cardiovascular disease and are at increased risk for morbidity and mortality. Results of recent studies have shown evidence of cardiovascular benefit with continuation of renin-angiotensin system (RAS) blockade for transplant naïve patients with CKD. However, according to Sophie McAllister and colleagues at the University of California San Francisco, there are few data available on whether cessation of RAS blockade among recipients of kidney transplant confers cardiovascular or survival benefits (or risks).

The researchers conducted a retrospective cohort study of kidney transplant recipients from the FAVORIT (Folic Acid for Vascular Outcome Reduction in Transplantation) study. Results of the current study were reported during a virtual poster session at ASN Kidney Week in a poster titled Discontinuation of Renin-Angiotensin System Blockade among Kidney Transplant Recipients.

The study included FAVORIT participants enrolled in the United States who received an angiotensin receptor blocker or an angiotensin-converting enzyme inhibitor by self-report at one or more FAVORIT visits. The risks or benefits of RAS discontinuation (versus continuation) was assessed using a propensity score weighted Cox survival analysis. Outcomes of interest were death, return to dialysis, and major adverse cardiovascular events (MACE [stroke, myocardial infarction, coronary revascularization, or heart failure]). Doubly robust estimation was also used on the propensity score weighted sample to provide conservative estimates.

A total of 2009 US participants had at least one visit where they reported taking a RAS inhibitor. Thirty percent (n=598) discontinued RAS blockade. Compared with participants who continued RAS blockade, those who discontinued RAS blockade were significantly less likely to experience mortality, return to dialysis, and MACEs.

In conclusion, the researchers said, “Kidney transplantation recipients who stopped RAS blockade had lower rates of mortality, return to dialysis, and MACEs compared with those who continued RAS blockade. These data may be useful when deciding on the risks and  benefits of continuing RAS blockade for patients receiving kidney transplantation.”

Source: McAllister S, Siyahian S, Seth D, Ku E. Discontinuation of renin-angiotensin system blockade among kidney transplantation recipients. Abstract of a poster presented at the American Society of Nephrology virtual Kidney Week 2021 (Abstract PO2118), November 2021.