The renin-aldosterone axis in kidney transplant recipients and its association with allograft function and structure

The level of the renin–angiotensin–aldosterone system (RAAS) activity in kidney transplant recipients has not been extensively studied or serially profiled. To describe this axis and to determine its association with glomerular filtration rate (GFR) change, interstitial expansion, and end-stage renal disease (ESRD), we measured plasma renin activity (PRA) and plasma aldosterone levels annually for 5 years in 153 kidney transplant recipients randomly assigned to losartan or placebo.

PRA and plasma aldosterone levels were in the normal range at all times and did not vary by immunosuppression regimen. Those on losartan exhibited higher PRA but similar plasma aldosterone levels. Neither baseline nor serial PRA or plasma aldosterone levels were associated with GFR decline, proteinuria, or interstitial expansion. Losartan use (hazard ratio (HR) 0.48 (95% confidence interval (CI) 0.21–1.0), insignificant) and Caucasian donor (HR 0.18 (95% CI 0.07–0.4) significant) were associated with less doubling of serum creatinine, death, or ESRD.

Authors: Naim Issa, Fernando Ortiz, Scott A Reule, Aleksandra Kukla, Bertram L Kasiske, Michael Mauer, Scott Jackson, Arthur J Matas and Hassan N Ibrahim
Reference: Kidney Int 85: 404-415; advance online publication, August 21, 2013;



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