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Proteinuria, ace inhibitor or Angiotensin II receptor blocker and survival in kidney transplant recipients in Bulgaria

Author: 
Vera Stamenova, Maya Petrova, Tanya Metodieva, Borelli Zlatkov, Jean Filipov, Martin Lubih and Emil Paskalev
Subject Area: 
Life Sciences
Abstract: 

Background: After kidney transplantation proteinuria not only indicates graft pathology, but contributes to disease progression, graft loss and worse patient outcomes. Treatment of the underlying cause may not always result in normalizing protein excretion rates. Angiotensin converting enzyme inhibitors (ACEinh) or angiotensin receptor blockers (ARBs) treatment in kidney transplant recipients is a field of debate and ongoing research focusing on patient survival and delaying the need for dialysis after kidney transplantation. Methods: We performed a retrospective single center study on 277 patients who received a kidney transplant between 01.01.2005 and 31.12.2010. We ran a Log Rank test and univariate and multivariate Cox regression analysis to study the effect of proteinuria and ACEinh/ARB treatment on survival. In patients with biopsy proven graft pathology (N 91) we compared survival rates of patients with and without ACEinh/ARB treatment. Results: Proteinuria at 3 months post transplantation significantly lowered patient (p=0.021) and graft survival (overall and censored for death –p<0.001 and p=0.004). Proteinuria was an independent factor for worse outcomes for the overall graft survival (HR 1.718, 95% CI 1.072 to 2.752, p=0.024) and graft survival censored for death (HR 3.866, 95% CI 1.968 to 7.598, p<0.001). Treatment with ACEinh/ARBs had a significant effect on proteinuria excretion after 12 months (p=0.005), on patient survival in the whole cohort (HR 0.437, 95% CI 0.198 to 0.967, p=0.041) and in patients with biopsy proven graft pathology (p=0.029). Conclusions: Kidney transplant recipients benefit from receiving treatment with an ACEinh/ARB, especially in the presence of proteinuria and proven graft pathology.

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