Abstract
BackgroundAlthough immunoglobulin A nephropathy (IgAN) is associated with an increased risk of renal allograft failure, evidences for its treatment, including renin-angiotensin-aldosterone system blockade (RAASB) usage, remain limited.MethodsIn this bi-center retrospective cohort study, we included patients who were recently diagnosed with IgAN through allograft biopsies. We identified their 6-month antihypertensive medication prescriptions and investigated the association between the medication types, albuminuria changes, and risk of 5-year death-censored-graft-failure (DCGF). The mixed effect model and cox regression analysis were used.ResultsA total of 464 allograft IgAN patients were included: 272, 38, 33, and 121 patients in the no antihypertensive medication, single agent RAASB, single agent beta blocker (BB)/calcium channel blocker (CCB), and combination therapy groups, respectively. High-degree albuminuria after 6 months of allograft IgAN diagnosis was an important prognostic parameter and a partial mediator for the association between the subgroups and 5-year DCGF. The usage of single RAASB was associated with decrement of albuminuria from allograft IgAN diagnosis (P for interaction = 0.03). The single BB/CCB group demonstrated significantly worse prognosis than the single RAASB group (adjusted hazard ratio, 2.76 [1.09–6.98]; P = 0.03).ConclusionsIn conclusion, RAASB may be beneficial for graft prognosis in early allograft IgAN patients who require single antihypertensive medication therapy, by means of reducing albuminuria. Further investigation of treatment strategy in allograft IgAN is warranted.
Highlights
Immunoglobulin A nephropathy (IgAN) is associated with an increased risk of renal allograft failure, evidences for its treatment, including renin-angiotensin-aldosterone system blockade (RAASB) usage, remain limited
Study population Of the 559 allograft immunoglobulin A nephropathy (IgAN) patients, 464 patients were included in the current study after exclusion criteria were applied (Fig. 1)
The age and sex distributions were similar between the groups, the single RAASB group had a significantly longer duration from transplant to allograft IgAN diagnosis
Summary
Immunoglobulin A nephropathy (IgAN) is associated with an increased risk of renal allograft failure, evidences for its treatment, including renin-angiotensin-aldosterone system blockade (RAASB) usage, remain limited. The development or recurrence of IgAN in allograft is associated with an increased risk of graft failure in the long-term [5, 6] This accelerated graft dysfunction has been repetitively observed [4, 7, 8], evidence for treatment strategies of allograft IgAN remains limited. Whether RAASB usage is associated with better prognosis for primary glomerulonephritis in allograft, including IgAN [17, 18], is uncertain, even though a clinical guideline recommend its usage with a low-grade recommendation level [19]
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