Metabolic Effect of Telmisartan and Candesartan in Kidney Transplant Patients

Introduction

While kidney transplantation for end-stage renal failure reduces the risk of cardiovascular (CV) events, this risk remains high and is a major cause of reduced survival in these patients. Approximately 80% of kidney transplant patients suffer from hypertension. Hyperlipidemia and abnormal glucose metabolism, which can arise for example due to immunosuppressive therapy, further exacerbate CV risk.

Telmisartan is an angiotensin II receptor blocker (ARB) with a unique ability to selectively modulate peroxisome proliferator-activated receptors gamma (PPAR-γ). PPAR-γ play an important role in regulating insulin sensitivity and lipid metabolism. Telmisartan is the only ARB shown in several clinical studies to improve glucose and lipid metabolism. The presented study aimed to explore this effect in the specific group of kidney transplant patients.

Methods and Study Design

A total of 46 kidney transplant patients with established ARB treatment for hypertension were enrolled in the prospective randomized crossover study. Inclusion criteria included controlled blood pressure < 130/80 mm Hg and ARB use for at least 3 months. Renal function of patients was normal, and immunosuppressants were administered at a stable dose. Patients with diabetes were not included in the study, and no new cases of diabetes were identified among participants during the study.

Participants were randomized into two groups receiving telmisartan (n = 23) or candesartan (n = 23). After 12 weeks of treatment, the treatment arms were switched, and the treatment continued for another 12 weeks. After each study phase, laboratory parameters of lipid and glucose metabolism, blood pressure, and graft function were evaluated.

Results

A total of 40 patients completed the study. No significant difference in blood pressure was observed between the treatment groups during the follow-up. Telmisartan, compared to candesartan, resulted in a significant reduction in triglyceride levels (telmisartan 1.30 ± 0.57 mmol/l vs. candesartan 1.54 ± 0.75 mmol/l; p = 0.019) and an increase in estimated glomerular filtration rate (telmisartan 50.4 ± 15.1 ml/min/1.73 m² vs. candesartan 48.5 ± 12.5 ml/min/1.73 m²; p = 0.038).

Other parameters – adiponectin, LDL cholesterol, HDL cholesterol, fasting glucose, glycosylated hemoglobin (HbA_1c), glycosylated albumin, fasting insulin, serum creatinine, high-sensitivity C-reactive protein (hs-CRP), homeostasis model assessment of insulin resistance (HOMA-IR), and urine protein/creatinine ratio – did not show significant differences depending on whether telmisartan or candesartan was administered.

Conclusion

Telmisartan improves serum triglyceride levels and glomerular filtration rate in kidney transplant patients more significantly than candesartan.

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Source: Miura, Y., Noguchi, H., Okabe, Y., et al. Effects of telmisartan and candesartan on the metabolism of lipids and glucose in kidney transplant patients: a prospective, randomized crossover study. Transplant Direct 2019; 5 (2): e423, doi: 10.1097/TXD.0000000000000861.