The renin-angiotensin-aldosterone system blockade and arterial stiffness in renal transplant recipients – a cross-sectional prospective observational clinical study

Zbigniew Heleniak; Sarah Illersperger; Susanne Brakemeier; Paul Bach; Alicja Dębska-Ślizień; Klemens Budde; Fabian Halleck

doi:10.18388/abp.2020_5490

Zbigniew Heleniak Department of Nephrology, Transplantology and Internal Medicine Medical University of Gdansk, Poland, Gdańsk, Poland https://orcid.org/0000-0002-3284-0149
Sarah Illersperger Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin Charité - Universitätsmedizin Berlin
Susanne Brakemeier Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin Charité - Universitätsmedizin Berlin
Paul Bach Humboldt-Universität zu Berlin School of Business and Economics Applied Statistics, Berlin Germany
Alicja Dębska-Ślizień Department of Nephrology, Transplantology and Internal Medicine Medical University of Gdansk, Gdańsk, Poland
Klemens Budde Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin Charité - Universitätsmedizin Berlin
Fabian Halleck Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin Charité - Universitätsmedizin Berlin

DOI: https://doi.org/10.18388/abp.2020_5490

Abstract

Introduction. Arterial stiffness parameters can be used as a predictor of cardiovascular events in the general population and renal transplant recipients (RTRs). Additionally, the renin-angiotensin-aldosterone-system (RAAS) blockade mitigates arterial stiffness in the general population. There are no sufficient data concerning the role of the RAAS blockade in reducing arterial stiffness among patients after kidney transplantation. The aim of this study is to assess the influence of the above blockade on arterial stiffness in RTRs. Methods. 344 stable RTRs were enrolled in the study. 204 (59.3%) of them received RAAS blockers (angiotensin convertase inhibitors – ACEIs or angiotensin receptor blockers – ARBs): group RAAS (+), and 140 (40.7%) were not treated with such agents: group RAAS (–). Results. In the RAAS (+) group, 55.9% of the patients used ARBs and 44.1% ACEIs. Cardiovascular disease (coronary artery disease and/or peripheral obliterans artery disease) (27.9% vs 14.3%, p<0.05), and heart failure (27.4% vs 24.3%, p<0.05) were significantly more often diagnosed in the RAAS (+) group when compared to the RAAS (–) group. Systolic blood pressure, diastolic blood pressure and all arterial stiffness parameters (baPWV, cfPWV, pulse pressure) did not differ significantly between the RAAS (+) and RAAS (–) groups. The results revealed that cardiovascular disease in patients was associated with a significant increase in both, the PWV and pulse pressure. No difference between the arterial stiffness parameters was observed in patients with a cardiovascular disease, diabetes and heart failure in the RAAS (+) and RAAS (–) groups. Moreover, beta-blockers and diuretics ameliorated the arterial stiffness parameters. Conclusions: This study showed the indication bias of the RAAS prescription, and no conclusion on the influence of RAAS on arterial stiffness can be drawn. The results indicated diuretics and beta-blockers as agents lowering the arterial stiffness in RTRs.