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Published on: February 2, 2021
Short-term Effects of Losartan on Cardiovascular Risk and Allograft Injury Biomarkers in Kidney Transplant Recipients
Izabella Kuźmiuk-Glembin1, Zbigniew Heleniak1, Renata Pięta2
1Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
Background:
There is a controversy over the renoprotective and cardioprotective effects of renin-angiotensin-aldosterone system blockade in kidney transplant recipients (KTRs). The aim of the study was to evaluate the short-term effects of losartan on allograft injury, cardiovascular risk biomarkers and safety of the treatment in KTRs.
Methods:
An interim analysis of a prospective, open, multicenter, controlled clinical trial CELART (Cardiovascular Effects of Losartan After Renal Transplantation) was performed. KTRs were allocated to losartan (L) 50 to 100 mg or standard hypotensive treatment (ST) group to reach target blood pressure (BP) <140/90 mm Hg. The short-term effects of the therapy were evaluated after 6 months: estimated glomerular filtration rate (eGFR), albuminuria, the intrarenal fibrosis biomarkers: urine excretion of transforming growth factor β-1 (TGFβ-1) and procollagen type III amino terminal propeptide (PIIINP), cardiac biomarker: serum concentration of N-terminal-pro-B-type natriuretic peptide (NT-proBNP), 24-hour ambulatory BP measurement, and hemoglobin and potassium concentrations.
Results:
At baseline the groups did not differ with respect to age, primary nephropathy, comorbidity, immunosuppressive therapy, albuminuria, and graft function. A total of 61 (L group) and 73 (ST group) patients reached the target BP and completed protocol at 6 months. After 6 months of therapy there were no significant differences in changes of eGFR, albuminuria, hemoglobin and potassium concentrations, urine excretion of PIIINP, and TGFβ-1 between groups. There was a trend in the L group to decrease the concentration of serum NT-proBNP.
Conclusions:
Losartan shows minimal adverse effects and no influence on graft function and biomarkers of graft fibrosis. It may have a positive effect on cardiovascular risk in KTRs. Further interim analyses of the CELART study will be conducted.
Insights
Losartan demonstrated minimal adverse effects in kidney transplant recipients (KTRs) with no impact on graft function or fibrosis biomarkers. However, it showed a potential cardiovascular benefit, warranting further investigation in KTRs.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Controversy exists regarding the renoprotective and cardioprotective effects of renin-angiotensin-aldosterone system blockade in kidney transplant recipients (KTRs).
- Evaluating losartan's short-term impact on allograft injury and cardiovascular risk markers in KTRs is crucial.
Purpose of the Study:
- To assess the short-term effects of losartan versus standard hypotensive treatment on allograft injury and cardiovascular risk biomarkers in kidney transplant recipients.
- To evaluate the safety and efficacy of losartan in this patient population.
Main Methods:
- An interim analysis of the prospective, open-label, multicenter, controlled CELART clinical trial.
- Kidney transplant recipients were randomized to receive either losartan (50-100 mg) or standard hypotensive treatment to achieve a target blood pressure <140/90 mm Hg.
- Short-term effects were evaluated at 6 months, measuring estimated glomerular filtration rate (eGFR), albuminuria, fibrosis biomarkers (TGFβ-1, PIIINP), cardiac biomarker (NT-proBNP), and blood pressure.
Main Results:
- No significant differences were observed between the losartan and standard treatment groups in changes of eGFR, albuminuria, hemoglobin, potassium, PIIINP, or TGFβ-1 after 6 months.
- Both groups successfully reached the target blood pressure.
- A trend towards decreased serum NT-proBNP levels was noted in the losartan group.
Conclusions:
- Losartan exhibits minimal adverse effects and does not negatively influence graft function or fibrosis biomarkers in KTRs.
- Losartan may offer a potential cardiovascular benefit in kidney transplant recipients.
- Further interim analyses of the CELART study are planned to confirm these findings.
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01:26Kidney Transplant II: Surgical Procedure
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01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention