Preservation of Renal Structure and Function at 2 Years without Calcineurin Inhibitor Use

Abstract

The recent report of Flechner et al. (1) indicated important differences in slope of GFR and renal histology, but not hard outcomes such as death or graft loss, between patients treated with cyclosporine-based immunosuppression versus sirolimus-based immunosuppression. While clearly of great interest, despite randomization, important potential confounders were not accounted for in the study. Such confounders include systolic blood pressure (2), and use of anti-proteinuric medications including angiotensin converting enzyme (ACE) inhibitors (3) and angiotensin receptor blockers (ARB) (4).