A high sodium intake reduces antiproteinuric response to renin–angiotensin–aldosterone system blockade in kidney transplant recipients

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 1 g/day in 46 patients (44.7%). High uNa/Cr was associated with a smaller proteinuria decrease ( r = −0.251, p = 0.011). The percentage of 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 = 0.047]. High uNa/Cr independently relates (OR 2.406 per 100 mEq/g, 95% CI: 1.008–5.745, p = 0.048) 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.