The renin-aldosterone axis in kidney transplant recipients and its association with allograft function and structure.
Issa N,Ortiz F, et al.Kidney International 2014;85(2):404-15
Aims
To evaluate the association of renin-angiotensin-aldosterone activity and glomerular filtration change, interstitial expansion and end stage renal disease (ESRD) in kidney transplant recipients. The study also examined whether higher plasma renin activity and plasma aldosterone levels would be associated with inferior allograft function and structure.
Interventions
Participants were administered either losartan 100mg/day or placebo, shortly after transplantation.
Participants
153 kidney transplant recipients.
Outcomes
The outcomes included cortical interstitial volume fraction (Vvint/C) measured on the 5 year biopsy, glomerular filtration rate, albumin-creatinine ratio, doubling of VvInt/C or end stage renal disease (ESRD) from interstitial fibrosis/tubular atrophy, doubling of Vvint/C or any ESRD, or doubling of serum creatinine, all-cause ESRD or death.
Follow-up
5 years.
CET Conclusions
This is a follow up to the angiotensin-II blockade in chronic allograft nephropathy trial in which plasma renin activity and plasma aldosterone levels were measured at baseline and annually in 153 trial participants for 5 years. At approximately two months after transplantation recipients had been randomised to receive either placebo or 100mg of losartan (an angiotensin- II blocker). Although angiotensin-II blockade suppressed the renin-angiotensin-aldosterone system (RAAS) effectively, there was no relationship between plasma renin activity or plasma aldosterone activity on glomerular filtration rate, proteinuria or interstitial expansion. The authors conclude that systematic RAAS is not overly activated in kidney transplant recipients, but note that this may not reflect activity within the transplanted kidney.
Data analysis
Available case analysis
Quality notes
Previously assessed Ibrahim et al. Angiotensin ll blockade in kidney transplant recipients. Journal of American Society Nephrology 2013; 24: 320-327.
Trial registration
ClinicalTrials.gov - NCT01467895