title: A high sodium intake reduces antiproteinuric response to renin-angiotensin-aldosterone system blockade in kidney transplant recipients.
abstract: BACKGROUND
  Post-transplant proteinuria is associated with lower graft and patient survival. Renin-angiotensin-aldosterone system blockers are used to reduce proteinuria and improve renal outcome. Although it is known that a high salt intake blunts the antiproteinuric effect of ACEI and ARB drugs in non-transplant patients, this effect has not been studied in kidney transplant recipients.
  
  
  OBJECTIVE
  To analyse the relationship between sodium intake and the antiproteinuric effect of ACEI/ARB drugs in kidney transplant recipients.
  
  
  METHODS
  We selected 103 kidney transplant recipients receiving ACEI/ARB drugs for more than 6 months due to proteinuria>1 g/day. Proteinuria was analysed at baseline and at 6 months after starting ACEI/ARB treatment. Salt intake was estimated by urinary sodium to creatinine ratio (uNa/Cr).
  
  
  RESULTS
  Proteinuria fell to less than 1g/day in 46 patients (44.7%). High uNa/Cr was associated with a smaller proteinuria decrease (r=-0.251, P=.011). The percentage proteinuria reduction was significantly lower in patients in the highest uNa/Cr tertile [63.9% (IQR 47.1%), 60.1% (IQR 55.4%), 38.9% (IQR 85.5%), P=.047]. High uNa/Cr independently relates (OR 2.406 per 100 mEq/g, 95% CI: 1.008-5.745, P=.048) to an antiproteinuric response <50% after renin-angiotensin-aldosterone system blockade.
  
  
  CONCLUSIONS
  A high salt intake results in a smaller proteinuria decrease in kidney transplant recipients with proteinuria treated with ACEI/ARB drugs.
authors.affiliation: Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
authors.forename: Elena
authors.initials: E
authors.lastname: Monfá
authors.affiliation: Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España. Electronic address: nefrce@humv.es.
authors.forename: Emilio
authors.initials: E
authors.lastname: Rodrigo
authors.affiliation: Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
authors.forename: Lara
authors.initials: L
authors.lastname: Belmar
authors.affiliation: Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sango
authors.affiliation: Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
authors.forename: Fozi
authors.initials: F
authors.lastname: Moussa
authors.affiliation: Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Ruiz San Millán
authors.affiliation: Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
authors.forename: Celestino
authors.initials: C
authors.lastname: Piñera
authors.affiliation: Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
authors.forename: Gema
authors.initials: G
authors.lastname: Fernández-Fresnedo
authors.affiliation: Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Arias
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000150:complications*; D012084:Renin-Angiotensin System; D012982:Sodium, Dietary / Q000008:administration & dosage*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D012982:Sodium, Dietary
keywords: Angiotensin; Angiotensin II receptor blocker; Angiotensin-converting-enzyme inhibitor; Angiotensina; Antagonistas del receptor de angiotensina; Inhibidores de la enzima convertidora de angiotensina; Kidney transplantation; Proteinuria; Renin; Renina; Trasplante renal