{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T01:58:19Z","timestamp":1788141499804,"version":"build-2803163510"},"reference-count":63,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>Despite the reduction in the incidence of acute rejection, a major risk factor for graft loss, there has been only modest improvement in long-term graft survival. Most cases of kidney graft loss have an identifiable cause that is not idiopathic fibrosis\/atrophy or calcineurin inhibitor nephrotoxicity. Distinct immunologic and nonimmunologic factors conspire to lead to a common pathway of allograft fibrosis. It remains plausible that mitigating nonimmunologic damage using strategies proven effective in native kidney disease may yield benefit in kidney transplantation. In this review, we will focus on nonimmunologic aspects of kidney transplant care that may prove to be valuable adjuncts to a well-managed immunosuppression regimen. Topics to be addressed include the roles of hypertension and agents used to treat it, lipid lowering, sodium and water intake, elevated uric acid, metabolic acidosis, and the use of sodium-glucose cotransporter 2 inhibitors on long-term kidney transplant health.<\/jats:p>","DOI":"10.2215\/cjn.15070920","type":"journal-article","created":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T12:10:56Z","timestamp":1616501456000},"page":"1890-1897","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":13,"title":["Thinking Outside the Box: Novel Kidney Protective Strategies in Kidney Transplantation"],"prefix":"10.2215","volume":"16","author":[{"given":"Hassan N.","family":"Ibrahim","sequence":"first","affiliation":[{"name":"Division of Renal Diseases and Hypertension, Department of Medicine, Houston Methodist Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina N.","family":"Murad","sequence":"additional","affiliation":[{"name":"Division of Renal Diseases and Hypertension, Department of Medicine, Houston Methodist Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg A.","family":"Knoll","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,12]]},"reference":[{"key":"B1-20241015","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1093\/ndt\/gfu205","article-title":"Risk of death following kidney allograft failure: A systematic review and meta-analysis of cohort studies","volume":"29","author":"Kabani","year":"2014","journal-title":"Nephrol Dial Transplant"},{"key":"B2-20241015","article-title":"Mortality and morbidity in kidney transplant recipients with a failing graft: A matched cohort study [published online ahead of print April 14, 2020]","author":"Lam","journal-title":"Can J Kidney Health Dis"},{"key":"B3-20241015","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1097\/TP.0000000000002125","article-title":"Establishing a core outcome measure for graft health: A Standardized Outcomes in Nephrology-Kidney Transplantation (SONG-Tx) consensus workshop report","volume":"102","author":"Tong","year":"2018","journal-title":"Transplantation"},{"key":"B4-20241015","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1111\/ajt.14694","article-title":"Kidney transplant graft outcomes in 379 257 recipients on 3 continents","volume":"18","author":"Merion","year":"2018","journal-title":"Am J Transplant"},{"key":"B5-20241015","doi-asserted-by":"crossref","first-page":"2812","DOI":"10.1681\/ASN.2017020148","article-title":"Effects of intensive BP control in CKD","volume":"28","author":"Cheung","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"B6-20241015","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1503\/cmaj.121468","article-title":"Effects of intensive blood pressure lowering on the progression of chronic kidney disease: A systematic review and meta-analysis","volume":"185","author":"Lv","year":"2013","journal-title":"CMAJ"},{"key":"B7-20241015","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1001\/jama.283.5.633","article-title":"Arterial hypertension and renal allograft survival","volume":"283","author":"Mange","year":"2000","journal-title":"JAMA"},{"key":"B8-20241015","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1681\/ASN.2013040435","article-title":"BP, cardiovascular disease, and death in the folic acid for vascular outcome reduction in transplantation trial","volume":"25","author":"Carpenter","year":"2014","journal-title":"J Am Soc Nephrol"},{"key":"B10-20241015","doi-asserted-by":"crossref","first-page":"e127","DOI":"10.1016\/j.jacc.2017.11.006","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"B11-20241015","first-page":"337","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) blood pressure work group. 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