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Randomized Controlled Trial
. 2008 Apr 1;70(5):1546-51.
doi: 10.1016/j.ijrobp.2007.08.041. Epub 2007 Oct 29.

Captopril to mitigate chronic renal failure after hematopoietic stem cell transplantation: a randomized controlled trial

Eric P Cohen  1 , Amy A Irving, William R Drobyski, John P Klein, Jakob Passweg, Julie-An M Talano, Mark B Juckett, John E Moulder
Affiliations
Randomized Controlled Trial

Captopril to mitigate chronic renal failure after hematopoietic stem cell transplantation: a randomized controlled trial

Eric P Cohen et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: To test whether the angiotensin-converting enzyme inhibitor captopril was effective in mitigating chronic renal failure after hematopoietic stem cell transplantation (HSCT).

Methods and materials: A total of 55 subjects undergoing total body irradiation (TBI)-HSCT were enrolled in this randomized controlled trial. Captopril or identical placebo was started at engraftment and continued as tolerated until 1 year after HSCT.

Results: The baseline serum creatinine and calculated glomerular filtration rate (GFR) did not differ between groups. The 1-year serum creatinine level was lower and the GFR higher in the captopril compared with the placebo group (p = 0.07 for GFR). Patient survival was higher in the captopril compared with the placebo group, but this was also not statistically significant (p = 0.09). In study subjects who received the study drug for more than 2 months, the 1-year calculated GFRs were 92 mL/min and 80 mL/min, for the captopril and placebo groups, respectively (p = 0.1). There was no adverse effect on hematologic outcome.

Conclusions: There is a trend in favor of captopril in mitigation of chronic renal failure after radiation-based HSCT.

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Conflict of interest statement

Conflicts of interest

No conflicts of interest exist

Figures

Figure 1
Figure 1
Diagram of patient recruitment and accrual to this study
Figure 2
Figure 2
The cumulative incidence of BMT nephropathy and HUS according to use of captopril or placebo. The occurrence of BMT nephropathy and HUS was within the first year after the BMT, as has been the case for BMT nephropathy in previous studies (6,12). The placebo group had a higher rate than the captopril group, but this did not attain statistical significance (p=0.1)
Figure 3
Figure 3
The actuarial patient survival according to use of captopril or placebo. There was better patient survival in the subjects of the captopril group, with a possible increasing survival advantage over time. This survival difference did however not attain statistical significance (p=0.09)
See this image and copyright information in PMC

References

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    1. Zager RA. Acute renal failure in the setting of bone marrow transplantation. Kidney Int. 1994;46:1443–58. - PubMed
    1. Cohen EP, Piering WF, Kabler-Babbitt C, Moulder JE. End-stage renal disease after bone marrow transplantation: poor survival compared to other causes of ESRD. Nephron. 1998;79:408–412. - PubMed
    1. Weiss AS, Sandmeier BM, Storer B, et al. Chronic kidney disease following non-myeloablative hematopoietic cell transplantation. Am J Transplant. 2006;6:89–94. - PubMed
    1. Deconinck E, Kribs M, Rebibou JM, et al. Cytomegalovirus infection and chronic graft versus host disease are significant predictors of renal failure after allogeneic hematopoietic stem cell transplantation. Haematologia. 2005;90:569–570. - PubMed

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