Blood pressure lowering for kidney transplant recipients: systematic review with network meta-analysis.

Valeria Saglimbene, Suetonia C Palmer, Andrea Iannone, Jonathan Craig, Allison Jaure, Patrizia Natale, Giovanni F M Strippoli, Amanda Sluiter

Journal: Journal of hypertension 2024;42(5):848-855

PMID: 38230619

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Abstract

OBJECTIVE

Hypertension affects 50-90% of kidney transplant recipients and is associated with cardiovascular disease and graft loss. We aimed to evaluate the comparative benefits and harms of blood pressure lowering agents in people with a functioning kidney transplant.

METHODS

We conducted a systematic review with network meta-analysis of randomized controlled trials (RCTs). We searched MEDLINE, Embase, and CENTRAL through to October 2023. RCTs evaluating blood pressure lowering agents administered for at least 2 weeks in people with a functioning kidney transplant with and without preexisting hypertension were eligible. Two reviewers independently extracted data. The primary outcome was graft loss. Treatment effects were estimated using random effects network meta-analysis, with treatment effects expressed as an odds ratio (OR) for binary outcomes and mean difference (MD) for continuous outcomes together with their 95% confidence interval (CI). Confidence in the evidence was assessed using GRADE for network meta-analysis.

RESULTS

Ninety-four studies (7547 adults) were included. Two studies were conducted in children. No blood pressure-lowering agent reduced the risk of graft loss, withdrawal because of adverse events, death, cardiovascular or kidney outcomes compared with placebo/other drug class. Angiotensin-converting enzyme inhibitors and angiotensin receptor blocker therapy may incur greater odds of hyperkalemia compared with calcium channel blockers [odds ratio (OR) 5.48, 95% confidence interval (CI) 2.47-12.16; and OR 8.67, 95% CI 2.65-28.36; low certainty evidence, respectively).

CONCLUSION

The evidentiary basis for the comparative benefits and safety of blood pressure lowering agents in people with a functioning kidney transplant is limited to guide treatment decision-making.

Address: Sydney School of Public Health, The University of Sydney, New South Wales, Australia.; Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari.; Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.; Sydney School of Public Health, The University of Sydney, New South Wales, Australia.; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.; Sydney School of Public Health, The University of Sydney, New South Wales, Australia.; Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari.; Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari.; College of Medicine and Public Health, Flinders University, Adelaide, Australia.

DOI: 10.1097/HJH.0000000000003663

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MeSH Terms: Child, Adult, Humans, Blood Pressure, Kidney Transplantation, Hypertension, Angiotensin-Converting Enzyme Inhibitors