The recommendation to limit sodium to 80–100 mmol/day

is in line with current guidelines for the general population,25 however, clinicians should emphasize adequate fluid intake over sodium restriction in the immediate post-transplant period. The suggestion to lower sodium intake further to 65–70 mmol/day is in line with the Suggested Dietary Lumacaftor in vivo Target for chronic disease prevention set by the National Health and Medical Research Council and the New Zealand Ministry for Health25 and recently adopted by the National Heart Foundation of Australia.26 There is no evidence from human studies that a sodium intake of 80–100 mmol has an adverse effect on the health of kidney transplant recipients. Animal studies27–29 have concluded that a low sodium intake may amplify the nephrotoxic effect of cyclosporine. However, these studies examined the effect of sodium depletion rather than a moderate sodium restriction and cannot be applied to human low sodium diets. L-arginine is the precursor of nitric oxide, which promotes vasodilation thus lowering blood pressure. In a randomized crossover study, Kelly et al.21 investigated the effect of L-arginine supplementation (at a dose of 4.5 g consumed twice per day) over a period of 2 months on blood pressure. The study suggests that

the supplement is well-tolerated and effective in significantly reducing systolic blood pressure (SBP) (P = 0.03) and that SBP remained significantly Decitabine price lower than baseline after a 1-month washout period and after a further 2 months of supplementation. While diastolic blood pressure (DBP) did not decrease significantly PAK6 in the first 2 months, it was significantly lower than baseline after the 1-month washout and the following 2 months. After

supplementation was ceased, both SBP and DBP increased significantly. The key problems with this study were: Small number of subjects (27 with only 20 completing the study). Because of the problems associated with the design, it is not possible to state definitively whether or not L-arginine supplementation is an effective adjunct therapy for blood pressure control. There are no published studies exploring the effect of weight loss on blood pressure among kidney transplant recipients. However, weight loss in the general population is known to significantly decrease blood pressure.14 There is strong evidence from studies on the general population that particular lifestyle and dietary measures assist in the management of hypertension.10–16,30 Guidelines have been produced on the basis of this evidence.17–19,31 The Dietary Approaches to Stop Hypertension (DASH) and DASH-sodium trials13,32 were controlled feeding dietary trials that lowered blood pressure in the absence of weight loss.