Short-term outcome after kidney transplantation is excellent, but long-term survival is limited, with chronic transplant dysfunction as important contributor. The mineralocorticoid (MC) aldosterone is essential for sodium and potassium homeostasis, but it may also adversely affect the renal allograft by exerting profibrotic and pro-inflammatory effects on the kidney. We therefore aimed to investigate the associations of serum aldosterone with graft function and graft failure in prednisolone-treated renal transplant recipients (RTR).
Baseline measurements were performed between 2001 and 2003 in outpatient RTR with a functioning graft >1 yr. Follow-up was recorded until May 2009. Graft failure was defined as return to dialysis or re-transplantation. Serum aldosterone concentration was measured by Siemens Coat-A-Count® Radioimmunoassay, which has no cross-reactivity with prednisolone.
A total of 566 RTR (age 51±12 yrs, 55% men) were studied. Median [IQR] aldosterone concentration was 0.28 [0.16-0.44] nmol/l. Aldosterone was higher in females than in males (P<0.001). It was positively associated with proteinuria (r=0.16, P=0.002) and use of antihypertensive drugs (r=0.13, P=0.002), and inversely associated with serum sodium (r=-0.08, p=0.04), 24h sodium excretion (r=-0.12, P=0.005), and creatinine clearance (r=-0.22, P<0.001). There was no association with serum potassium or prednisolone dose. During follow-up for 6.9 [6.1-7.4] years, 51 (9.2%) RTR experienced graft failure. In a univariate Cox-regression analysis, serum aldosterone was positively associated with graft failure (HR=1.76 [95%CI 1.32-2.35], P=0.001). This association remained significant after adjustment for age, sex, cardiovascular risk factors, and sodium status (HR=1.48 [95%CI 1.08-2.03], P=0.01).
In this prospective cohort study in RTR, findings on serum aldosterone are consistent with suppression by high sodium availability, and adverse effects on blood pressure and graft function on the long-term. Intervention with aldosterone blockade might be beneficial in prednisolone-treated RTR.
To cite this abstract in AMA style:Vries Lde, Kerstens M, Kobold AMuller, Kema I, Sanders J, Navis G, Bakker S. Serum Aldosterone and Graft Function in Prednisolone-Treated Renal Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/serum-aldosterone-and-graft-function-in-prednisolone-treated-renal-transplant-recipients/. Accessed November 29, 2020.
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