Acidosis and hyperkalemia caused by losartan and enalapril in pediatric kidney transplant recipients.
OBJECTIVE
To evaluate the efficacy and safety of losartan and enalapril in pediatric kidney transplant recipients.


METHODS
A retrospective review was performed in 31 pediatric kidney transplant recipients who were treated with losartan (50 mg/d, oral) for 1 to 6 months because of mild hypertension and persistent proteinuria. All patients were treated concurrently with enalapril (5 or 10 mg daily, oral), and 12 patients (39%) also were treated with amlodipine (5 or 10 mg daily, oral). Demographic and clinical characteristics of the patients were reviewed.


RESULTS
Losartan use was associated with a significant decrease in mean systolic (before losartan was started, 123 ± 14 mm Hg; before losartan was stopped, 111 ± 10 mm Hg; P ≤ .001) and diastolic blood pressure (before losartan was started, 78 ± 11 mm Hg; before losartan was stopped, 69 ± 10 mm Hg; P ≤ .001) and urinary protein excretion (before losartan was started, 51 ± 45 mg/m2/h; before losartan was stopped, 28 ± 34 mg/m2/h; P ≤ .001). However, losartan therapy was associated with a significant mean increase in serum potassium level (before losartan was started, 4.0 ± 0.4 mmol/L; before losartan was stopped, 5.7 ± 0.5 mmol/L; P ≤ .001) and decrease in pH (before losartan was started, 7.35 ± 0.0; before losartan was stopped, 7.23 ± 0.0; P ≤ .001). Losartan was stopped because of hyperkalemia and acidosis earlier in patients who were on tacrolimus than cyclosporine immunosuppression (tacrolimus, 3 ± 1 mo; cyclosporine, 4.7 ± 0.8 mo; P ≤ .001).


CONCLUSIONS
Losartan and enalapril may be beneficial in pediatric kidney transplant recipients by decreasing blood pressure and proteinuria, with maintenance of stable graft function, but may be associated with serious adverse events including hyperkalemia and life-threatening acidosis.
Division of Pediatric Nephrology,Baskent University Faculty of Medicine, Ankara, Turkey.
Hale
H
Sakallı
Esra
E
Baskın
Umut Selda
US
Bayrakcı
Gökhan
G
Moray
Mehmet
M
Haberal
D000138:Acidosis / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D000293:Adolescent; D000367:Age Factors; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006947:Hyperkalemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D019808:Losartan / Q000009:adverse effects*; D008297:Male; D011188:Potassium / Q000097:blood; D011507:Proteinuria / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D015415:Biomarkers; D004656:Enalapril; D019808:Losartan; D011188:Potassium