Angiotensin II blockade in kidney transplant recipients

Hassan N. Ibrahim, Scott Jackson, Jeffery Connaire, Arthur Matas, Arthur Ney, Behzad Najafian, Ann West, Nicole Lentsch, Jensina Ericksen, Jenny Bodner, Bertram Kasiske, Michael Mauer

Research output: Contribution to journalArticle

59 Scopus citations

Abstract

Interstitial fibrosis/tubular atrophy (IF/TA) contributes to the loss of kidney allografts, and treatment or preventive options are lacking. We conducted a double-blind, randomized, placebo-controlled trial to determine whether angiotensin II blockade prevents the expansion of the cortical interstitial compartment, the precursor of fibrosis. We randomly assigned 153 transplant recipients to receive losartan, 100 mg (n=77), or matching placebo (n=76) within 3 months of transplantation, continuing treatment for 5 years. The primary outcome was a composite of doubling of the fraction of renal cortical volume occupied by interstitium from baseline to 5 years or ESRD from IF/TA. In the intention-to-treat analysis, using only patients with adequate structural data, the primary endpoint occurred in 6 of 47 patients who received losartan and 12 of 44 who received placebo (odds ratio [OR], 0.39; 95%confidence interval [CI], 0.13-1.15; P=0.08).We found no significant effect of losartan on time to a composite of ESRD, death, or doubling of creatinine level. In a secondary analysis, losartan seemed to reduce the risk of a composite of doubling of interstitial volume or all-cause ESRD (OR, 0.36; 95% CI, 0.13-0.99; P=0.05), but this finding requires validation. In conclusion, treatment with losartan did not lead to a statistically significant reduction in a composite of interstitial expansion or ESRD from IF/TA in kidney transplant recipients.

Original languageEnglish (US)
Pages (from-to)320-327
Number of pages8
JournalJournal of the American Society of Nephrology
Volume24
Issue number2
DOIs
StatePublished - Jan 31 2013

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    Ibrahim, H. N., Jackson, S., Connaire, J., Matas, A., Ney, A., Najafian, B., West, A., Lentsch, N., Ericksen, J., Bodner, J., Kasiske, B., & Mauer, M. (2013). Angiotensin II blockade in kidney transplant recipients. Journal of the American Society of Nephrology, 24(2), 320-327. https://doi.org/10.1681/ASN.2012080777