Renin-Angiotensin System Blockade and Long-term Clinical Outcomes in Kidney Transplant Recipients: A Meta-analysis of Randomized Controlled Trials.
Hiremath S, Fergusson DA, et al.American Journal of Kidney Diseases 2017; 69(1): 78-86.
Aims
To conduct a systematic review and meta-analysis to evaluate the efficacy of renin-angiotensin system (RAS) blockade in kidney transplant recipients.
Interventions
The databases Embase and Medline were searched up to November 2015, as well as the Cochrane Central Register of Controlled Trials (Up to third quarter 2015) and PubMed (May through December 2015 for recent non-indexed citations). Randomized controlled trials, with a follow-up of 1 year or longer that evaluated the use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in kidney transplant recipients and reported outcomes of interest were included.
Participants
8 trials (1,502 participants) were included in the systematic review.
Outcomes
The primary outcomes measured were transplant survival and patient survival. The secondary outcome measured was the risk for doubling of creatinine level.
Follow-up
Median follow-up was 1.5 years (Range: 1-10).
CET Conclusions
This updated analysis of a previously reported systematic review evaluated the efficacy of renin-angiotensin system (RAS) blockade in adult kidney transplant recipients. The comprehensive bibliographic search included eight randomised controlled trials (1,502 patients) that compared RAS blockade (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker) with active medication, placebo or usual care that reported at least a 1-year follow up. Two investigators independently selected eligible studies and extracted data. The Cochrane Risk of Bias tool showed that study quality was reasonable although for many trials the risk of bias was unclear for several domains, in particular for allocation concealment and blinding. Pooled analyses showed no differences in mortality, graft loss or doubling of serum creatinine. Heterogeneity was assessed with the Cochran Q-statistic and I2 and was not significant for all pooled analyses. Pooled analysis of five trials showed that the risk for hyperkalemia was significantly higher in patients treated with RAS blockade. The authors correctly conclude that their analysis does not give definitive evidence regarding the efficacy of RAS blockade because of the small number of trials and included patients, and low event rate.
Quality notes
Quality assessment not appropriate
Trial registration
PROSPERO - CRD42016033226