Effects Of Losartan On Levels Of Serum Uric Acid And Hemoglobin In Renal Transplant Recipients And Its Safety Evaluation

Objective:To evaluate the influence of Losartan on levels of serum uric acid(SUA), hemoglobin(Hb),serum creatinine(SCr) and estimated glomerular filtration rate(eGFR) in patients after renal transplantation.The safety of losartan in these patients was also evaluated.Method:Sixty-six renal transplant patients with stable allograft function and serum creatinine levels below 176.8umol/l(2mg/dl) were divided into treatment group(n=34) treated with losartan at a dose of 50mg/day and concrol group(n=32) didn't use losartan. Angiotensin-converting enzyme inhibitor(ACEi) and other ARB were excluded during the study.Each Participant was followed for 6 months and differences in SCr,SUA,Hb, whole blood CsA trough concentration,blood pressure(BP) and GFR(estimated by the MDRD formula) were compared at baseline,and at months 1,2,3 and 6.Results:Nine patients in treatment group were withdrawn due to acute renal insufficiency, anaemia,acute rejection,and discontinuation of losartan while five were withdrawn in control group.BP were significantly decreased compared with the baseline in losartan group and were more closer to the target pressure than control group.Downtrend was present in the SUA in losartan group and significant difference were occured since the month 2(P<0.05 vs baseline ),while uptrend was present in control but no statistical significance was displayed.For patients SUA≥420umol/L,the SUA showed a significant decrease in the losartan group,while the control maintaining high.For patients SUA <420umol/L,the SUA showed stable in losartan group but rised in control group although no significant difference was found.SCr in losartan group showed a slight,but significant increase at month 1(p<0.05 vs baseline ),then gradually returning to baseline until month 6.Relatively,the estimated glomerular filtration rate(eGFR) in losartan group was decreased slightly and temporarily.The Hb level in losartan group kept on dropping in the first two months(p<0.01 vs baseline ), then remaining stable since month 3.An uptrend of Hb was seen in the control but had no statistical significance.For patients Hb≥160g/L,a progressive decrease in Hb was observed after losartan treatment(P<0.01 vs baseline ) while a slight,non-significant decrease was in the control.For patients Hb <160umol/L,Hb in losartan group decreased in the first two months(p<0.01 vs baseline at month 2 ),then gradually rising to baseline since month 3 to month 6.A progressive increase of Hb was seen in control group(P<0.05 vs baseline).Conclutions:Losartan can effectively relieve and prevent hyperuricemia and posttransplantation erythrocytosis(PTE) following renal transplantation.There was a short term increase of SCr due to a slight decrease of eGFR at the beginning of administer.Some recipients may have safety problems in use of losartan.