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2015 ; 29
(3
): 261-7
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Daily fluid intake and outcomes in kidney recipients: post hoc analysis from the
randomized ABCAN trial
#MMPMID25619874
Weber M
; Berglund D
; Reule S
; Jackson S
; Matas AJ
; Ibrahim HN
Clin Transplant
2015[Mar]; 29
(3
): 261-7
PMID25619874
show ga
Generous and even excessive fluid intake is routinely recommended to kidney
transplant recipients despite minimal evidence to support this practice. We
hypothesized that increased fluid intake, ascertained by 24-h urine volume
output, may adversely affect graft outcomes as it would impose an extra workload
on a limited number of nephrons. Kidney transplant recipients who were randomized
to losartan vs. placebo in the Angiotensin II Blockade for Chronic Allograft
Nephropathy (ABCAN) trial (n = 153) underwent baseline, five-yr biopsies, and
annual iothalamate glomerular filtration rate assessment. Recipients with higher
urine volume at randomization had higher urinary sodium and also higher urinary
protein. The proportion using diuretics or CNI based regimens were similar across
urinary volume tertiles. The highest urinary volume tertile (>2.56 L/d) did not
predict the development of interstitial volume doubling or end-stage renal
disease (ESRD) from interstitial fibrosis/tubular atrophy (OR = 3.52, 95% CI 0.4,
31.24, p = 0.26), interstitial volume doubling or all-cause ESRD (OR = 7.04, 95%
CI 0.66, 74.87, p = 0.11), and was not associated with the conventional endpoint
of doubling serum creatinine, all-cause ESRD, or death (OR = 0.89, 95% CI 0.21,
3.71, p = 0.87). These results suggest that the current practice of liberal fluid
intake may not be beneficial in low risk and mostly Caucasian transplant
recipients.