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or non-specific findings&#44; except in those with proteinuria above 1500<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; in which glomerular involvement was predominant&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> The factors inducing the onset of proteinuria include&#58; transplant from a female donor to a male recipient&#59; advanced donor age&#59; kidney function&#59; blood pressure&#59; cell rejection and antibody-mediated rejection&#59; recurrence of glomerulonephritis&#59; prolonged warm and cold ischaemia&#59; and delayed initiation of graft function&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The measures currently used to reduce post-transplant proteinuria include strict control of blood pressure&#44; renin&#8211;angiotensin&#8211;aldosterone system &#40;RAAS&#41; blockade with angiotensin-converting enzyme &#40;ACE&#41; inhibitors or angiotensin receptor II blockers &#40;ARBs&#41;&#44; lipid control&#44; stop smoking and maintaining a healthy weight&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> Specifically&#44; the KDIGO guidelines recommend using ACE inhibitors or ARBs in patients with recurrent glomerulonephritis and proteinuria and in hypertensive patients with proteinuria &#8805;1<span class="elsevierStyleHsp" style=""></span>g&#47;day&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the general population&#44; RAAS blockade has been shown to be effective in reducing proteinuria&#44; controlling hypertension and reducing the progression of chronic kidney disease &#40;CKD&#41; in patients with diabetic and non-diabetic nephropathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;10</span></a> Although some studies have demonstrated the efficacy of the antiproteinuric effect of RAAS blockade in kidney transplantation&#44;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;12</span></a> there is no precise information on the efficacy of proteinuria reduction on preservation of renal function and improvement of graft and patient survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">12&#8211;16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In non-transplant CKD patients&#44; several factors can reduce the antiproteinuric effect of RAAS blockade&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">17&#8211;22</span></a> Salt intake is one of these factors&#46; One meta-analysis that included 11 studies was able to quantify that albuminuria was decreased by 32&#46;1&#37; for every reduction in sodium intake of 92<span class="elsevierStyleHsp" style=""></span>mEq&#47;day&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> None of the cohorts considered in the meta-analysis included kidney transplant patients&#46; The aim of our study was to assess the relationship between sodium intake and the antiproteinuric effect of ACE inhibitors and ARBs in our population of kidney transplant patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study population and design</span><p id="par0025" class="elsevierStylePara elsevierViewall">We selected 137 patients from a population of 1423 kidney transplants performed at our site between October 1986 and May 2012&#46; Patients included were those&#58; &#40;1&#41; who have been transplanted for more than 3 months &#40;2&#41; had proteinuria greater than 1<span class="elsevierStyleHsp" style=""></span>g&#47;day&#59; &#40;3&#41; who had been treated with ACE inhibitors or ARBs for more than 6 months&#59; and &#40;4&#41; had a urinary sodium&#47;creatinine ratio value available before starting treatment with ACE inhibitors or ARBs&#46; We excluded 34 patients with changes in plasma creatinine greater than 25&#37; before starting ACE inhibitors or ARBs&#44; and patients who had modified their diuretic therapy in the month before starting ACE inhibitors or ARBs or over the 6 months of follow-up&#46; In our unit&#44; all patients are trained to perform an accurate collection of a 24-h urine protein test in each routine visit&#44; and all receive specific dietary advice to follow a diet low in fat and salt&#46; A total of 40 patients &#40;38&#46;8&#37;&#41; were on diuretic therapy&#46; The doses of ACE inhibitors and ARBs were standardised for an equivalent dose of enalapril according to previous drug guidelines and studies on the antiproteinuric effect with equivalent doses&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23&#8211;25</span></a> The study was conducted in accordance with the criteria set forth in the Declaration of Helsinki&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Data collection</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patient characteristics and laboratory data were collected at the beginning of the RAAS blockade and at 6 months &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; and they were extracted prospectively from the database of kidney transplant patients from our site&#46; The variables collected were ages of the donor and recipient&#44; weight&#44; cause of CKD&#44; cause of proteinuria&#44; immunosuppressive drugs&#44; time since transplant at the beginning of the RAAS blockade and laboratory data&#46; Proteinuria was determined by the pyrogallol red-molybdate &#40;PRM&#41; method for the 24-h urine protein test&#46; Sodium intake was estimated by 24-h urinary sodium excretion and normalised with creatinine with the sodium&#47;creatinine ratio to avoid possible errors in the collection&#46; Blood pressure was measured 3 times&#44; separated by 5<span class="elsevierStyleHsp" style=""></span>min by an automatic system&#44; and the final reading was used&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Categorical variables were expressed as relative frequencies and continuous variables as the mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#44; except for those who had normal distribution&#44; which were reported as median and interquartile range &#40;IQR&#41;&#46; Tertiles for the urinary sodium&#47;creatinine ratio were established&#44; and salt intake was estimated &#40;&#60;87<span class="elsevierStyleHsp" style=""></span>mEq&#47;g&#59; between 87 and 138<span class="elsevierStyleHsp" style=""></span>mEq&#47;g&#59; &#62;138<span class="elsevierStyleHsp" style=""></span>mEq&#47;g&#59; cut-offs of 87 and 138<span class="elsevierStyleHsp" style=""></span>mEq&#47;g are equivalent to 6&#46;4 and 9&#46;4<span class="elsevierStyleHsp" style=""></span>g of salt per day&#41;&#46; Proteinuria&#44; urinary sodium&#47;creatinine ratio&#44; creatinine clearance in urine&#44; kidney function and serum potassium were compared at baseline and at 6 months using the Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired samples&#46; The relationship between quantitative variables was analysed by correlation analysis&#46; The Kruskal&#8211;Wallis test was used to establish the relationship between the percentage of decrease in proteinuria and the tertiles of urinary sodium&#47;creatinine ratio&#46; Inadequate antiproteinuric response was defined as a percentage of reduction in proteinuria of less than 50&#37;&#46; The risk factors for inadequate antiproteinuric response were analysed using the Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#44; Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test and Chi-squared test&#46; A multivariate logistic regression analysis was conducted with all significant variables&#46; A <span class="elsevierStyleItalic">p</span>-value &#60;5&#37; was considered statistically significant&#46; SPSS version 15&#46;0 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41; was used to perform the analysis&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Patient characteristics at baseline and at 6 months are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; In all&#44; 55&#46;4&#37; of patients received ACE inhibitors and 44&#46;6&#37;&#44; ARBs&#46; Six months after starting the RAAS blockade&#44; serum creatinine and potassium levels increased&#44; systolic and diastolic BP decreased&#44; and 24-h proteinuria was significantly reduced &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; By contrast&#44; there were no significant differences at 6 months in urinary sodium or creatinine elimination&#44; nor in urinary sodium&#47;creatinine ratio &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In 46 patients &#40;44&#46;7&#37;&#41; proteinuria was reduced below one gram after 6 months of RAAS blockade&#46; We found no significant differences in the initial sodium&#47;creatinine ratio amongst patients with and without diuretic treatment &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;083&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A high urinary sodium&#47;creatinine ratio was associated with a smaller reduction in proteinuria at 6 months &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;251&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#41; and a lower percentage of decreased proteinuria from baseline proteinuria &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;211&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;033&#41;&#46; Similarly&#44; the percentage of reduction in proteinuria from baseline was significantly lower in patients in the highest tertile for the urinary sodium&#47;creatinine ratio &#91;63&#46;9&#37; &#40;IQR 47&#46;1&#37;&#41;&#59; 60&#46;1&#37; &#40;IQR 55&#46;4&#37;&#41;&#59; 38&#46;9&#37; &#40;IQR 85&#46;5&#37;&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;047&#93; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The decrease in the absolute value for proteinuria at 6 months was lower for the highest tertile&#44; but was not statistically significant &#91;1161<span class="elsevierStyleHsp" style=""></span>mg &#40;IQR 2406<span class="elsevierStyleHsp" style=""></span>mg&#41;&#59; 978<span class="elsevierStyleHsp" style=""></span>mg &#40;IQR 1299<span class="elsevierStyleHsp" style=""></span>mg&#41;&#59; 696<span class="elsevierStyleHsp" style=""></span>mg &#40;IQR 1422<span class="elsevierStyleHsp" style=""></span>mg&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;056&#93;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the factors that are in relation with a percent reduction of in proteinuria of less than 50&#37; &#40;52 patients&#41;&#46; The use of mTOR inhibitors and a lower urinary sodium&#47;creatinine ratio was significantly related to a reduction in proteinuria greater than 50&#37;&#46; Neither serum creatinine nor glomerular filtration rate were associated with the percent decreased in proteinuria &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; or reduction of proteinuria in absolute values &#40;data not shown&#41;&#46; The doses of ACE inhibitors and ARBs standardised for enalapril were not associated with the decreased in proteinuria &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;149&#41;&#46; Using a logistic regression analysis&#44; including the significant variables &#40;use of mTOR inhibitors and sodium&#47;creatinine ratio&#41;&#44; the urinary sodium&#47;creatinine ratio was the only factor related independently &#40;OR 2&#46;406 by 100<span class="elsevierStyleHsp" style=""></span>mEq&#47;g&#44; 95&#37; CI&#58; 1&#46;008&#8211;5&#46;745&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048&#41; to an inadequate antiproteinuric response after RAAS blockade in kidney transplant recipients&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">As in previous studies in transplant and non-transplant patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;26</span></a> we have observed that RAAS blockers significantly reduce proteinuria&#46; After 6 months of treatment&#44; mean proteinuria was reduced from 3&#46;6 to 2&#46;2<span class="elsevierStyleHsp" style=""></span>g&#47;day&#44; and in almost half of patients &#40;44&#46;7&#37;&#41; proteinuria fell below 1<span class="elsevierStyleHsp" style=""></span>g&#47;day&#46; The advantages of the use of ACE inhibitors&#47;ARBs in kidney transplants remain controversial&#44; with studies where there is no histological improvement&#44; and no change in graft or patient survival&#44; or in the cardiovascular risk<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">15&#44;16&#44;27</span></a>&#59; others studies show an increase in patient survival&#44; but not in the graft survival<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a>&#59; and there are also studies showing an improvement in both graft and patient survival&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> In this latter study&#44; the greatest benefit on graft outcome was observed in patients with higher proteinuria&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> Whether due to a specific effect of RAAS blockade&#44; or not&#44; what is clear is that the reduction of short-term albuminuria has a long-term nephroprotective effect&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In a meta-analysis of 21 clinical trials that included 78&#44;342 patients&#44; Heerspink et al&#46; observed that for every 30&#37; reduction in albuminuria achieved with RAAS blockade&#44; the risk to reach stage 5 CKD was reduced by 32&#37; in the long term analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> The reduction of approximately 39&#37; in proteinuria observed in our study with RAAS blockers may lead to a reduction in the loss of long-term renal grafts of more than 30&#37;&#44; although this effect should be evaluated in long-term studies&#46; In contrast to the general population&#44; in the kidney transplant population the reduction of proteinuria with ACE inhibitors&#47;ARBs has not been demonstrated to be reduce the progression of renal disease&#46; This may be due to the characteristics of the transplant patients &#40;i&#46;e&#46; immunosuppressive therapy&#44; especially with calcineurin inhibitors and alloimmune damage&#41; as well as to methodological problems&#46; For example&#44; in the meta-analysis by Heerspink et al&#46;&#44; a sample size of less than 1250 patient or the cause of the nephropathy affected the ability of the studies to show any benefit from RAAS blockade&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> In kidney transplantation it is difficult to conduct long-term studies with large numbers of patients enough to demonstrate the long-term benefit of ACE inhibitors and ARBs&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The effect of low-salt diet on BP is recognised both in the transplant population as well as in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> However&#44; many patients with CKD have a salt intake above the WHO recommendations &#40;below 5<span class="elsevierStyleHsp" style=""></span>g&#47;day&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> Amongst kidney transplant recipients&#44; up to 87&#37; have a urinary sodium excretion that reflects a salt intake above 5<span class="elsevierStyleHsp" style=""></span>g&#46; In addition&#44; salt intake is maintained over time in each patient and in the overall population&#44; despite the recommendations made&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">31&#44;33&#44;34</span></a> This suggests that&#44; despite some difficulties&#44; we have an opportunity to improve outcomes in kidney transplant recipients by intensifying dietary measures without requiring drug&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The main finding of our study is that a high-salt diet limits the antiproteinuric effect of ACE inhibitors and ARBs in the kidney transplant population&#44; similar to previously published studies of CKD patients&#46; In a prospective study of 500 non-diabetic patients with CKD&#44; Vegter et al&#46; showed that patients in the highest tertile of urinary sodium&#47;creatinine ratio showed a minor decrease in proteinuria with ramipril &#40;20&#37;&#41; compared with patients with lower salt intake &#40;25&#37; and 31&#37;&#41;&#44; leading to an increased risk of developing stage 5 CKD&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> In our kidney transplant patients the percent reduction in proteinuria in the different tertiles of sodium&#47;creatinine ratio &#40;from to the highest to the lowest&#41; was 16&#37;&#44; 41&#37; and 43&#37;&#44; respectively&#46; The antiproteinuric effect of low-salt diet has been proven to be more effective even than double RAAS blockade&#44; or as effective as diuretic therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">18&#44;20</span></a> Thus&#44; in a randomised study of 52 patients with non-diabetic nephropathy&#44; the reduction in proteinuria caused by adding a low-salt diet to treatment with ACE inhibitors was significantly greater than the reduction of proteinuria by adding ARBs to ACE inhibitors &#40;51&#37; vs&#46; 21&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> Also in 34 patients with proteinuria without diabetes&#44; in whom treatment with losartan decreased proteinuria by 30&#37;&#44; the addition of hydrochlorothiazide achieved a reduction of 56&#37;&#44; and of 55&#37; by adding a low-salt diet&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Therefore&#44; it seems advisable to insist that the transplant patients also must follow a diet low in salt&#44; especially in those with proteinuria who have not responded&#44; or responded only partially&#44; with RAAS blockade&#46; Given the differences between the highest tertile for salt intake and the middle and lower tertiles in our study&#44; we recommend at least a moderate decrease in sodium intake to improve the antiproteinuric response to treatment with ACE inhibitors&#47;ARBs&#44; without requiring a severe restriction&#46; It is foreseeable that&#44; in parallel to that observed in the non-transplant CKD population&#44; a greater reduction in proteinuria will contribute to improving renal graft survival&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The pathophysiological mechanisms that contribute to the antiproteinuric effect of salt restriction are not fully known&#46; In normal conditions&#44; salt intake is associated with an increase in serum sodium that triggers the thirst centre and stimulates the secretion of antidiuretic hormone&#46; All this leads to increased blood volume&#44; blood pressure and glomerular filtration rate&#46; This decreases the activating stimulus of renin&#44; which makes RAAS blockade less effective for hypertension and proteinuria&#46; If serum sodium decreases&#44; blood volume and blood pressure are also reduced&#59; the RAAS blockade is activated and becomes more effective&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> Furthermore&#44; sodium appears to play a role through the endothelium&#46; Verhave et al&#46; showed that salt intake increases albuminuria independently of blood pressure&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> a fact that reflects the specific endothelial damage&#46; We also found a relationship between changes in blood pressure and antiproteinuric response&#44; a finding previously described by some authors and which suggests that the reduction in proteinuria induced by salt restriction is influenced both by intraglomerular pressure and systemic BP&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> This endothelial damage could also be mediated by inflammatory mechanisms&#58; it has even been observed that high salt intake is associated with higher albuminuria and with elevated CRP in hypertensive patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">22&#44;36</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Analysing the factors that could be related to the antiproteinuric response&#44; we noted that the use of mTOR inhibitors is associated with a greater antiproteinuric response to ACE inhibitors&#47;ARBs&#44; although this finding was not confirmed in the multivariate analysis&#46; The use of ACE inhibitors&#47;ARBs has been shown to be effective in the literature in treating and even preventing proteinuria that develops after conversion from calcineurin inhibitors to mTOR inhibitors&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> Several mechanisms have been described that contribute to the onset of proteinuria with mTOR inhibitors&#46; Most times proteinuria develops after discontinuation of calcineurin inhibitors&#44; probably related to the interruption of their vasoconstrictor effect&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">38&#44;39</span></a> There are some assumptions that point to possible direct glomerular and tubular damage and there have been reported cases of focal and segmental glomerulosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">39&#44;40</span></a> There are no specific studies demonstrating a better antiproteinuric response with ACE inhibitors&#47;ARBs in patients treated with mTOR inhibitors&#46; To explain our findings&#44; we can speculate with 2 potential mechanisms&#58; &#40;1&#41; ACE inhibitors and ARBs reduce glomerular capillary pressure that would increase after the withdrawal of calcineurin inhibitors and beginning the mTOR inhibitor&#59; and 92&#41; both ACE inhibitors and ARBs reverse the damage mediated by angiotensin II&#44; specifically induced by mTOR on albumin uptake in the proximal tubule&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The main limitation of our study is that it is an observational study in which patients are on different drugs and different ACE inhibitors and ARBs&#46; However&#44; it does reflect routine clinical practice in that the doses are adjusted according to potassium&#44; creatinine and BP&#46; There were no different antiproteinuric responses seen when normalising to a standard dose of enalapril&#44; which can be explained because most patients were on 5<span class="elsevierStyleHsp" style=""></span>mg of enalapril and the same dose was maintained throughout the study period &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; As discussed above&#44; the absence of a relationship between changes in BP and the antiproteinuric effect of salt restriction indicates that low-salt diet exerts its additional antiproteinuric effect through partially independent mechanisms of lower BP and doses of ACE inhibitors&#47;ARBs&#46; A second limitation is that this is a single-centre study&#44; with a limited sample size&#46; However&#44; the significant relationship between urinary sodium&#47;creatinine ratio and antiproteinuric response indicates that there is an association between them&#46; There need to be larger&#44; multicentre&#44; prospective studies to confirm the role of sodium intake in the antiproteinuric response to RAAS blockade in renal transplant patients&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study indicates that&#44; in renal transplant patients with proteinuria treated with ACE inhibitors&#47;ARBs&#44; high salt intake is associated with a smaller decrease in proteinuria and possibly with lower graft survival&#46; Avoiding excessive salt intake is a necessary and effective measure that should be combined with RAAS blockade&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Keywords"
          "identificador" => "xpalclavsec781214"
          "palabras" => array:6 [
            0 => "Angiotensin"
            1 => "Angiotensin II receptor blocker"
            2 => "Angiotensin-converting-enzyme inhibitor"
            3 => "Proteinuria"
            4 => "Renin"
            5 => "Kidney transplantation"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec781215"
          "palabras" => array:6 [
            0 => "Angiotensina"
            1 => "Antagonistas del receptor de angiotensina"
            2 => "Inhibidores de la enzima convertidora de angiotensina"
            3 => "Proteinuria"
            4 => "Renina"
            5 => "Trasplante renal"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Post-transplant proteinuria is associated with lower graft and patient survival&#46; Renin&#8211;angiotensin&#8211;aldosterone system blockers are used to reduce proteinuria and improve renal outcome&#46; Although it is known that a high salt intake blunts the antiproteinuric effect of ACEI and ARB drugs in non-transplant patients&#44; this effect has not been studied in kidney transplant recipients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To analyse the relationship between sodium intake and the antiproteinuric effect of ACEI&#47;ARB drugs in kidney transplant recipients&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We selected 103 kidney transplant recipients receiving ACEI&#47;ARB drugs for more than 6 months due to proteinuria &#62;1<span class="elsevierStyleHsp" style=""></span>g&#47;day&#46; Proteinuria was analysed at baseline and at 6 months after starting ACEI&#47;ARB treatment&#46; Salt intake was estimated by urinary sodium to creatinine ratio &#40;uNa&#47;Cr&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Proteinuria fell to less than 1<span class="elsevierStyleHsp" style=""></span>g&#47;day in 46 patients &#40;44&#46;7&#37;&#41;&#46; High uNa&#47;Cr was associated with a smaller proteinuria decrease &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;251&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#41;&#46; The percentage of proteinuria reduction was significantly lower in patients in the highest uNa&#47;Cr tertile &#91;63&#46;9&#37; &#40;IQR 47&#46;1&#37;&#41;&#44; 60&#46;1&#37; &#40;IQR 55&#46;4&#37;&#41;&#44; 38&#46;9&#37; &#40;IQR 85&#46;5&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;047&#93;&#46; High uNa&#47;Cr independently relates &#40;OR 2&#46;406 per 100<span class="elsevierStyleHsp" style=""></span>mEq&#47;g&#44; 95&#37; CI&#58; 1&#46;008&#8211;5&#46;745&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048&#41; to an antiproteinuric response &#60;50&#37; after renin&#8211;angiotensin&#8211;aldosterone system blockade&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A high salt intake results in a smaller proteinuria decrease in kidney transplant recipients with proteinuria treated with ACEI&#47;ARB drugs&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La proteinuria postrasplante renal se asocia a una disminuci&#243;n en la supervivencia del injerto y del paciente&#46; Para reducir la proteinuria y mejorar el pron&#243;stico renal se recomienda asociar f&#225;rmacos bloqueantes del sistema renina-angiotensina-aldosterona &#40;RAA&#41;&#46; Aunque en los pacientes no trasplantados se ha demostrado que la dieta rica en sal reduce el efecto antiprotein&#250;rico de los IECA y ARA-II&#44; este efecto no se ha estudiado en los trasplantados renales&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Valorar la relaci&#243;n entre la ingesta de sodio y el efecto antiprotein&#250;rico de los IECA&#47;ARA-II en los trasplantados renales&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Seleccionamos a 103 trasplantados tratados con IECA&#47;ARA-II m&#225;s de 6 meses por proteinuria &#62; 1 g&#47;d&#237;a&#46; La proteinuria se analiz&#243; al inicio del tratamiento y a los 6 meses&#46; La ingesta de sal se estim&#243; con el cociente urinario sodio&#47;creatinina &#40;uNa&#47;Cr&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En 46 pacientes &#40;44&#44;7&#37;&#41; la proteinuria disminuy&#243; &#60; 1 g&#47;d&#237;a&#46; Un uNa&#47;Cr elevado se relaciona con un menor descenso de la proteinuria &#40;r &#61; &#8722;0&#44;251&#59; p &#61; 0&#44;011&#41;&#46; El porcentaje de reducci&#243;n de la proteinuria fue significativamente menor en los pacientes en el tercil m&#225;s alto de uNa&#47;Cr &#91;63&#44;9&#37; &#40;RIC 47&#44;1&#37;&#41;&#59; 60&#44;1&#37; &#40;RIC 55&#44;4&#37;&#41;&#59; 38&#44;9&#37; &#40;RIC 85&#44;5&#37;&#41;&#59; p &#61; 0&#44;047&#93;&#46; Un uNa&#47;Cr elevado se relaciona de forma independiente &#40;OR 2&#44;406 por 100 mEq&#47;g&#59; IC&#160;95&#37;&#58; 1&#44;008&#8211;5&#44;745&#59; p &#61; 0&#44;048&#41; a una respuesta antiprotein&#250;rica &#60; 50&#37; tras el bloqueo del eje RAA&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En los trasplantados renales con proteinuria tratados con IECA&#47;ARA-II una ingesta elevada de sal se asocia con un menor descenso de la proteinuria&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Antecedentes"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "M&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Monf&#225; E&#44; Rodrigo E&#44; Belmar L&#44; Sango C&#44; Moussa F&#44; Ruiz San Mill&#225;n JC&#44; et al&#46; La ingesta elevada de sodio disminuye la respuesta antiprotein&#250;rica del bloqueo del eje renina-angiotensina-aldosterona en el trasplante renal&#46; Nefrolog&#237;a&#46; 2016&#59;36&#58;545&#8211;551&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1273
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            "Tamanyo" => 69260
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Percentage decrease in proteinuria for each tertile of urinary sodium&#47;creatinine ratio&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ARBs&#58; angiotensin receptor antagonists&#59; CKD&#58; chronic kidney disease&#59; IFTA&#58; interstitial fibrosis and tubular atrophy&#59; ACE inhibitors&#58; angiotensin-converting enzyme inhibitors&#59; mTOR&#58; mammalian target of rapamycin&#59; IQR&#58; interquartile range&#59; BP&#58; blood pressure&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The standard deviation is shown in parentheses&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Recipient&#39;s age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Recipient&#39;s gender &#40;male&#41; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Weight &#40;kg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;064&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cause of CKD &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Glomerulonephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vascular&#47;nephroangiosclerosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Donor&#39;s age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Serum creatinine &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;16 &#40;0&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;42 &#40;1&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Glomerular filtration rate &#40;ml&#47;min&#47;1&#46;73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Potassium &#40;mEq&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;2 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Systolic BP &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">141 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Diastolic BP &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Urinary sodium&#47;creatinine ratio &#40;mEq&#47;g&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;940&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Urinary creatinine &#40;mg&#47;day&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1528 &#40;650&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1469 &#40;519&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;205&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Proteinuria &#40;mg&#47;day&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2200 &#40;IQR 3378&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1284 &#40;IQR 2196&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Proteinuria less than 1</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">g &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cause of proteinuria &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Glomerular involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IFTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>mTOR inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ACE inhibitors&#47;ARBs &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#46;6&#47;55&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Calcineurin inhibitors &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Azathioprine &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mycophenolate &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">mTOR inhibitors &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time from transplant to start of ACE inhibitor&#47;ARB &#40;days&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1097 &#40;IQR 2363&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ARBs&#58; angiotensin receptor antagonists&#59; IFTA&#58; interstitial fibrosis and tubular atrophy&#59; ACE inhibitors&#58; angiotensin-converting enzyme inhibitors&#59; mTOR&#58; mammalian target of rapamycin&#59; IQR&#58; interquartile range&#59; BP&#58; blood pressure&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The standard deviation is shown in parentheses&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50&#37;<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50&#37;<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Recipient&#39;s age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;068&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Recipient&#39;s gender &#40;male&#41; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Weight &#40;kg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;367&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Donor&#39;s age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;237&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Creatinine &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;22 &#40;0&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;10 &#40;0&#46;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;425&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Glomerular filtration rate &#40;ml&#47;min&#47;1&#46;73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;917&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Baseline systolic BP &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">142 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;556&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Baseline diastolic BP &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;663&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Systolic BP at 6 months &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">132 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">137 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Diastolic BP at 6 months &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;938&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Decreased systolic BP &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;9 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;7 &#40;17&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;415&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Decreased diastolic BP &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;6 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2 &#40;11&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;534&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Baseline urinary sodium&#47;creatinine ratio &#40;mEq&#47;g&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Third tertile urinary sodium&#47;creatinine ratio &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Urinary sodium&#47;creatinine ratio at 6 months &#40;mEq&#47;g&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">123 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;045&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Cause of proteinuria &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Glomerular involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;287&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IFTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>mTOR inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Use of mTOR inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Normalised enalapril dose &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;58&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;32&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time from transplant to start of ACE inhibitor&#47;ARB &#40;days&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1097 &#40;IQR 2630&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1111 &#40;IQR 1874&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;444&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Risk factors related to a percentage decrease in proteinuria of greater than 50&#37;&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
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