Compliance was assessed by the dietitian every 4 weeks and 24 h urinary sodium excretion was measured at baseline and at 3 months. Both systolic and diastolic

blood pressure levels decreased significantly (P < 0.0001) in the intervention group compared with those in the control group. Seven of the 18 in the intervention group needed lower doses or fewer antihypertensive medications. The investigators noted that while there was no correlation between urinary sodium excretion and blood pressure at baseline, after 3 months there was a correlation (P < 0.0001, r = 0.626). The limitations of the study were: Small numbers in each group. This study provides satisfactory level III evidence that the use of a sodium-restricted diet, in combination with buy PF-6463922 antihypertensive medications, helps to lower blood pressure in kidney transplant recipients. A prospective study by Curtis et al.20 compared the effect of a sodium-restricted diet on hypertensive adult kidney transplant recipients taking cyclosporine with those taking azathioprine. Subjects were selected sequentially on the basis of hypertension and stable graft function and treatment with cyclosporine and prednisone. Azathioprine-treated subjects were selected to match each cyclosporine-treated subject. There were five females and 10 males

in each group. To study the effect of sodium on blood pressure, subjects in both groups were placed on a ‘normal salt diet’ (150 mmol/day sodium) diet for 3 days, followed by a dose of captopril, followed by 4 days on a low sodium (9 mmol/day), then a high sodium diet of 3.8 mmol per kilogram body weight MAPK Inhibitor Library per day for 3 days. The researchers found that while a sodium restriction significantly

lowered blood pressure in cyclosporine-treated patients (P < 0.01), it had no effect on azathioprine-treated patients. In contrast, captopril lowered blood pressure in azathioprine-treated patients (P < 0.01) but not in cyclosporine-treated patients. While a sodium restriction of 9 mmol/day is unfeasible and unrealistic in the long term, it allowed the researchers to clearly demonstrate the existence of a difference between patients treated with cyclosporine and those Methamphetamine treated with azathioprine with respect to the mechanisms underlying hypertension. The study provides level III evidence that a sodium-restricted diet is more likely to lower blood pressure in hypertensive kidney transplant recipients treated with cyclosporine than in those treated with azathioprine. In addition to the prospective studies described above, cross-sectional studies have also been conducted to examine the association between sodium intake and blood pressure in kidney transplant recipients.22,23 In these studies, no correlation was found between urinary sodium excretion (surrogate marker of sodium intake) and blood pressure. The limitations of these studies included: No sub-group analysis according to medications.