Contrary to what is observed in developed countries, infectious complications are the main challenge with kidney transplantation in Brazil. Non-adherence to treatment also appears to contribute significantly to long-term kidney graft loss. Strategies for improvement should focus on better compliance and a greater safety profile of immunosuppressive treatment.

Raj et al 1 recently showed an increase in norepinephrine blood serum levels in patients with autonomic system failure after drinking water. This alteration had been reported previously in healthy subjects. Water ingestion rapidly raises sympathetic response and substantially increases the blood pressure levels, which is an important factor often unrecognized in clinical studies of pressor agents and antihypertensive medications. On the other hand, older hypertensive patients have greater reductions in blood pressure levels after a meal or after oral glucose ingestion than do age matched normotensive people. Postprandial decreases in systolic blood pressure have been found in the elderly patients without overt cardiovascular disease.We studied the systolic heart function of the 17 elderly hypertensive people after drinking water and eating a meal (10 men and 7 women, mean age: 69 years). All of them had a history of high blood pressure levels for Ն10 years, and they did not have postural hypotension and did not report other comorbidities. Patients with creatinine serum levels Ͻ2.5 mg% were included. Heart rate and blood pressure levels were measured by a semiautomated oscillometric device (Dixtal Instruments). The blood pressure values were considered to be the average of 3 sequential readings. Cardiac output (CO) and stroke volume were obtained by a thoracic bioimpedance instrument (NCCO-3, Bomed Instrumens). The total peripheral resistance was obtained using the equation (MAPϪCVP/CO)ϫ80, where CVP is the central venous pressure and MAP is the mean arterial pressure. Total peripheral resistance was expressed by dyne s Ϫ2 . In the morning, after an overnight fast (8:00 PM to 10:00 AM), the patients arrived at the laboratory, and anthropometric measurements were taken in all of them. After that, they rested for 30 minutes in a sit down position, and during this time the bioimpedance electrodes were attached to their thoraxes. At the end of the resting time, we gave the patients 500 mL of fresh water (2 glasses, 250 mL each) or a meal of 700 kcal, with a total volume of 500 g. The meal had 40% proteins, 30% lipids, and 30% carbohydrates. The average time for drinking or eating was 10 minutes. The patients who were randomly chosen to drink water the first day were invited to eat a meal the following day and vice versa. After ingestion of food or water, at the end of the resting time, we started to register the cardiac output, systolic volume, blood pressure levels, and heart rate. After fasting time, the patients were observed for 60 minutes, and we registered the average hemodynamic values at 5, 15, 30, 45, and 60 minutes. ANOVA and Tukey test were used to locate the differences.After ingestion of H 2 O, the systolic pressure levels increased at 30, 45, and 60 minutes. It increased from 164Ϯ2.7 to 175Ϯ 3.6 mm Hg (the highest significant value was observed at 45 minutes; PϽ0.05). The DBP did not change significantly, from 90Ϯ3.3 to 95Ϯ3.9 mm Hg (at 45 and 60 minutes; not significant, PϾ0.05). The MAP increased at 3...