期刊
NEPHROLOGY DIALYSIS TRANSPLANTATION
卷 16, 期 5, 页码 1034-1037出版社
OXFORD UNIV PRESS
DOI: 10.1093/ndt/16.5.1034
关键词
ACE inhibitors; angiotensin II receptor antagonists; CsA; renal transplantation; serum potassium; serum uric acid
Background. The angiotensin II (AT II) type I receptor antagonist losartan has been reported to increase urinary uric acid and potassium excretion. These effects might be beneficial in cyclosporin (CsA)-treated renal transplant recipients, who frequently suffer from hyperuricaemia and hyperkalaemia. Methods. In this prospective, open, randomized, two-way cross-over study we included 13 hypertensive CsA-treated patients after renal transplantation and administered either the angiotensin-converting enzyme (ACE) inhibitors enalapril or losartan. Laboratory parameters, 24-h urinary protein excretion, and mean 24-h arterial blood pressure (MAP) were checked after 3 weeks treatment with enalapril, after a wash-out period of 2 weeks. and before and after a 3-week treatment course with losartan. Results, Both drugs slightly reduced MAP (losartan from 97 +/- 6 to 94 +/- 9 and enalapril to 93 +/- 8 mmHg). Serum potassium levels significantly increased during enalapril therapy (from 4.3 +/- 0.5 to 4.8 +/- 0.4 mmol/l. P<0.05), as did. although not significantly, uric acid concentrations (from 7.8 +/- 1.9 to 8.2 +/- 1.8 mg/dl P=0.5). Losartan, on the contrary, only mildly affected serum potassium (4.3 +/- 0.5 vs 4.5 +/- 0.5 mmol/l, P=0.25) and serum uric acid decreased (from 7.8 +/- 2.4 to 7.3 +/- 1.8 mg/dl, P=0.6). Serum aldosterone and urinary aldosterone excretion were significantly reduced only during ACE inhibitor treatment, which might explain the variable effects on potassium homeostasis. Conclusion. Losartan may be a useful agent to reduce blood pressure and serum uric acid levels in renal transplant recipients treated with CsA. Furthermore, in this high-risk population, the effects on serum potassium levels are less mal ked with losartan than with enalapril.
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