Effect of Ramipril on Urinary Protein Excretion in Maintenance Renal Transplant Patients Converted to Sirolimus
| Autor: | Michael A. Tortorici, B. A. Marder, Huihua Li, Alison Flynn, C. Healy, J. Alberu, Didier A. Mandelbrot, Seth Schulman, A. Barama, Helio Tedesco Silva, Stuart M. Flechner |
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| Rok vydání: | 2015 |
| Předmět: |
Graft Rejection
Male Ramipril medicine.medical_specialty Calcineurin Inhibitors Urology Renal function Kidney Function Tests Placebo Tacrolimus chemistry.chemical_compound Postoperative Complications Double-Blind Method Risk Factors Humans Immunology and Allergy Medicine Pharmacology (medical) Prospective Studies Antihypertensive Agents Sirolimus Transplantation Creatinine Proteinuria business.industry Graft Survival Middle Aged Prognosis Kidney Transplantation Surgery Calcineurin Losartan chemistry Kidney Failure Chronic Female medicine.symptom business Immunosuppressive Agents Follow-Up Studies Glomerular Filtration Rate medicine.drug |
| Zdroj: | American Journal of Transplantation. 15:3174-3184 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/ajt.13384 |
| Popis: | This prospective, randomized, double-blind, placebo-controlled study evaluated the effects of ramipril on urinary protein excretion in renal transplant patients treated with sirolimus following conversion from a calcineurin inhibitor. Patients received ramipril or placebo for up to 6 weeks before conversion and 52 weeks thereafter. Doses were increased if patients developed proteinuria (urinary protein/creatinine ratio ≥0.5); losartan was given as rescue therapy for persistent proteinuria. The primary end point was time to losartan initiation. Of 295 patients randomized, 264 met the criteria for sirolimus conversion (ramipril, 138; placebo, 126). At 52 weeks, the cumulative rate of losartan initiation was significantly lower with ramipril (6.2%) versus placebo (23.2%) (p < 0.001). No significant differences were observed between ramipril and placebo for change in glomerular filtration rate from baseline (p = 0.148) or in the number of patients with biopsy-confirmed acute rejection (13 vs. 5, respectively; p = 0.073). One patient in the placebo group died due to cerebrovascular accident. Treatment-emergent adverse events were consistent with the known safety profile of sirolimus and were not potentiated by ramipril co-administration. Ramipril was effective in reducing the incidence of proteinuria for up to 1 year following conversion to sirolimus in maintenance renal transplant patients. |
| Databáze: | OpenAIRE |
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