Captopril to mitigate chronic renal failure after hematopoietic stem cell transplantation: a randomized controlled trial.
OBJECTIVE
To test whether the angiotensin-converting enzyme inhibitor captopril was effective in mitigating chronic renal failure after hematopoietic stem cell transplantation (HSCT).


METHODS
A total of 55 subjects undergoing total body irradiation (TBI)-HSCT were enrolled in this randomized controlled trial. Captopril or identical placebo was started at engraftment and continued as tolerated until 1 year after HSCT.


RESULTS
The baseline serum creatinine and calculated glomerular filtration rate (GFR) did not differ between groups. The 1-year serum creatinine level was lower and the GFR higher in the captopril compared with the placebo group (p = 0.07 for GFR). Patient survival was higher in the captopril compared with the placebo group, but this was also not statistically significant (p = 0.09). In study subjects who received the study drug for more than 2 months, the 1-year calculated GFRs were 92 mL/min and 80 mL/min, for the captopril and placebo groups, respectively (p = 0.1). There was no adverse effect on hematologic outcome.


CONCLUSIONS
There is a trend in favor of captopril in mitigation of chronic renal failure after radiation-based HSCT.
Cohen
Eric P
EP
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA. ecohen@mcw.edu
Irving
Amy A
AA
Drobyski
William R
WR
Klein
John P
JP
Passweg
Jakob
J
Talano
Julie-An M
JA
Juckett
Mark B
MB
Moulder
John E
JE
D000293:Adolescent; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002216:Captopril / Q000627:therapeutic use*; D002648:Child; D003404:Creatinine / Q000097:blood; D005919:Glomerular Filtration Rate; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014916:Whole-Body Irradiation / Q000009:adverse effects*
D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril; D003404:Creatinine