Purpose: Angiotensin-converting enzyme inhibitor ( ACEI) and angiotensin II receptor blocker (ARB) are frequently used in post transplant hypertension. Recent trials reported that renin-angiotensin-aldosterone system (RAAS) activation could trigger FGF23 and download Klotho synthesis , a mechanism that plays a role in their adverse influence on cardiovascular system. We cross-sectionally analysed the FGF23 and Klotho levels in a group of stable renal transplant patients and searched for the influence of antihypertensive drug use on FGF23 and Klotho levels.

Methods: A group of 160 RT recipients were included (median age 52 years old, 67 female, post transplantation duration median 58 months). Patients with stable creatinine levels and no history of acute rejection episodes in last 12 months were included. Serum samples for FGF 23 and Klotho were obtained during routine follow-up controls. Subjects were grouped according to their antihypertensive use: ACEI /ARB administered (n:78) and not using patients( none or any antihypertensive apart from ACEI/ARB (n: 82).

Results: Two groups were similar in means of demographic characteristics, medications and creatinine and creatinine clearance levels. Calcium, phosphorus, CaxP and PTH levels were similar. Patients using ACEI/ARB had significantly lower FGF-23 levels (49.5 vs 91.9 pg/mL, p: 0.049) and Klotho levels were significantly higher in this group (14.2 vs 9.2ng/mL, p: 0.04). FGF-23 levels were also positively correlated with PTH (r:0.221, p:0.049), creatinine (r:0.522, p:0.0001) and negatively correlated with calcium (r:-0.238, p:0.034) levels. Patients under ACEI/ARB treatment had significantly lower proteinuria (p: 0.03).

Conclusion: Posttransplant ACEI and ARB use is significantly associated with lower FGF23 and higher Klotho levels. We suggest that the beneficial influence of ACEI and ARB on long term graft function could take place through lowering these adverse prognostic markers.

CITATION INFORMATION: Sezer S, Tutal E, Bal Z, Uyar M, Haberal M. Treatments Against Renin-Angiotensin-Aldosterone System Could Influence FGF23 and Klotho Levels in Renal Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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