Urine Measurements of the Renin-Angiotensin System-Regulated Proteins Predict Death and Graft Loss in Kidney Transplant Recipients Enrolled in a Ramipril versus Placebo Randomized Controlled Trial.
Farkona, S., et al.Journal of Proteome Research 2025; 25(4): 2040-2052.
Aims
This post-hoc analysis of a randomised controlled trial aimed to investigate whether renin-angiotensin system (RAS)-regulated protein, measured in urine, can be used to predict cardiovascular and renal outcomes in renal transplant recipients.
Interventions
Participants in the original trial were randomised to either ramipril or placebo.
Participants
Urine biospecimens and clinical data from 56 kidney transplant recipients from the original RCT were analysed.
Outcomes
The main outcome of interest was the ablility of machine learning models and total urine protein to-creatinine ratio to predict graft loss, doubling of serum creatinine, death or any of the outcomes combined.
Follow-up
24 months post-randomisation
CET Conclusions
This interesting post-hoc analysis of sample from an RCT investigates the role of renin-angiotensin system regulated urinary protein excretion for prediction of adverse outcome in renal transplant recipients. The authors find an association between excretion of these proteins and graft loss, creating a predictive score with good discrimination for graft failure events that is able to predict adverse clinical outcomes using urine samples from over 2 years prior to a clinical event. There are some caveats. The sample is small, and the results possibly confounded by heterogenous immunosuppressive use, meaning that external validation in a larger sample is needed. It is not yet clear what the clinical utility of this could be – given that the authors find no impact of RAS-blocker use on protein excretion, the is no obvious intervention that might change the clinical course when protein excretion is detected to be high.
Trial registration
N/A