Safety of ACEI/ARB use in the early (<3 months) post kidney transplant period: a systematic review and meta-analysis
BackgroundData about the safety of ACEI/ARB use in early (<3 months) posttransplant period are restricted and remain controversial.MethodsThis systematic review and meta-analysis included searches of PubMed, Embase and CENTRAL from inception to 31 November 2023, for studies to compare the saf...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2024.1522558/full |
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| author | Dahai Fu Jin Li Guanglan Zeng Maozhi Tang |
| author_facet | Dahai Fu Jin Li Guanglan Zeng Maozhi Tang |
| author_sort | Dahai Fu |
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| description | BackgroundData about the safety of ACEI/ARB use in early (<3 months) posttransplant period are restricted and remain controversial.MethodsThis systematic review and meta-analysis included searches of PubMed, Embase and CENTRAL from inception to 31 November 2023, for studies to compare the safety (transplant outcomes and postoperative complications) of ACEI/ARB with non-ACEI/ARB (other antihypertensive medications) initiation in early post kidney transplant period.ResultsOf 1,247 citations identified, 13 eligible studies involving 1919 patients were enrolled for analyses. In short- or long-term observations, there were no differences on pooled serum creatinine between ACEI/ARB and non-ACEI/ARB groups whether initiated within 1 or 1–3 months posttransplant, however, initiation of ACEI/ARB within the first month posttransplant had an advantage effect on the mean creatinine clearance. Early initiation of ACEI/ARB posttransplant reduced the risks of patient death (RR 0.60, p = 0.009) and graft loss (RR 0.54, p = 0.0002). For postoperative complications, there were no significant differences in acute rejection risk (RR 0.87, p = 0.58), delayed graft function risk (RR 1.00, p = 0.93), hemoglobin level (MD -0.32 mg/Dl, p = 0.46) or urinary protein excretion (MD -0.10 g/24 h, p = 0.16) between two groups. However, the ACEI/ARB group had higher incidence of hyperkalemia (RR 2.43, p = 0.02).ConclusionEarly initiation of ACEI/ARB within 3 months posttransplant proved to be basically safe and has renal function recovery benefits, however, hyperkalemia needs to be noted. |
| format | Article |
| id | doaj-art-ed6eceb7e0bb48b2b8f714d1e6966595 |
| institution | Kabale University |
| issn | 1663-9812 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-ed6eceb7e0bb48b2b8f714d1e69665952024-12-11T04:27:31ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122024-12-011510.3389/fphar.2024.15225581522558Safety of ACEI/ARB use in the early (<3 months) post kidney transplant period: a systematic review and meta-analysisDahai Fu0Jin Li1Guanglan Zeng2Maozhi Tang3Department of Nephrology, Wushan County People’s Hospital of Chongqing, Chongqing, ChinaDepartment of Nephrology, Wushan County People’s Hospital of Chongqing, Chongqing, ChinaDepartment of Nephrology, Wushan County People’s Hospital of Chongqing, Chongqing, ChinaUrinary Nephropathy Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaBackgroundData about the safety of ACEI/ARB use in early (<3 months) posttransplant period are restricted and remain controversial.MethodsThis systematic review and meta-analysis included searches of PubMed, Embase and CENTRAL from inception to 31 November 2023, for studies to compare the safety (transplant outcomes and postoperative complications) of ACEI/ARB with non-ACEI/ARB (other antihypertensive medications) initiation in early post kidney transplant period.ResultsOf 1,247 citations identified, 13 eligible studies involving 1919 patients were enrolled for analyses. In short- or long-term observations, there were no differences on pooled serum creatinine between ACEI/ARB and non-ACEI/ARB groups whether initiated within 1 or 1–3 months posttransplant, however, initiation of ACEI/ARB within the first month posttransplant had an advantage effect on the mean creatinine clearance. Early initiation of ACEI/ARB posttransplant reduced the risks of patient death (RR 0.60, p = 0.009) and graft loss (RR 0.54, p = 0.0002). For postoperative complications, there were no significant differences in acute rejection risk (RR 0.87, p = 0.58), delayed graft function risk (RR 1.00, p = 0.93), hemoglobin level (MD -0.32 mg/Dl, p = 0.46) or urinary protein excretion (MD -0.10 g/24 h, p = 0.16) between two groups. However, the ACEI/ARB group had higher incidence of hyperkalemia (RR 2.43, p = 0.02).ConclusionEarly initiation of ACEI/ARB within 3 months posttransplant proved to be basically safe and has renal function recovery benefits, however, hyperkalemia needs to be noted.https://www.frontiersin.org/articles/10.3389/fphar.2024.1522558/fullkidney transplantangiotensin converting enzyme inhibitorangiotensin receptor blockersafetymeta-analysis |
| spellingShingle | Dahai Fu Jin Li Guanglan Zeng Maozhi Tang Safety of ACEI/ARB use in the early (<3 months) post kidney transplant period: a systematic review and meta-analysis Frontiers in Pharmacology kidney transplant angiotensin converting enzyme inhibitor angiotensin receptor blocker safety meta-analysis |
| title | Safety of ACEI/ARB use in the early (<3 months) post kidney transplant period: a systematic review and meta-analysis |
| title_full | Safety of ACEI/ARB use in the early (<3 months) post kidney transplant period: a systematic review and meta-analysis |
| title_fullStr | Safety of ACEI/ARB use in the early (<3 months) post kidney transplant period: a systematic review and meta-analysis |
| title_full_unstemmed | Safety of ACEI/ARB use in the early (<3 months) post kidney transplant period: a systematic review and meta-analysis |
| title_short | Safety of ACEI/ARB use in the early (<3 months) post kidney transplant period: a systematic review and meta-analysis |
| title_sort | safety of acei arb use in the early 3 months post kidney transplant period a systematic review and meta analysis |
| topic | kidney transplant angiotensin converting enzyme inhibitor angiotensin receptor blocker safety meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2024.1522558/full |
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