Please select the eligibility criteria that correspond to the clinical trial below.
Title: RAAS, Inflammation, and Post-operative AF
Brief Summary: Atrial fibrillation (AF) is the most prevalent, sustained type of irregular heartbeat and affects over 2 million Americans. Post-operative AF, which leads to significant morbidity and a prolonged hospital stay, complicates 20% to 40% of cardiopulmonary bypass (CPB) surgical procedures. While recent studies indicate that interruption of the renin-angiotensin-aldosterone system by either angiotensin-converting enzyme (ACE) inhibition or AT1 receptor antagonism decreases the incidence of AF following a heart attack or cardioversion (electric shock to the heart), its effect on the incidence of post-operative AF has not been throughly studied. Studies in both animals and humans suggest that inflammation-induced atrial remodeling plays an important role in the cause of AF. Recent studies also provide evidence that activation of the renin-angiotensin-aldosterone system induces inflammation, myocyte injury, proarrhythmic electrical remodeling, and fibrosis through aldosterone.


Options:
A: Inclusion Criteria:

1. Diagnosis of CKD at near-end stage renal failure (CKD Stage IV) ( eGFR = 15-30 mls/min).
2. Age \>18 years of age and \<85 years of age.
3. Males and post-menopausal, sterile women. Non-pregnant pre-menopausal women should be on adequate contraception and have no intention of becoming pregnant during the duration of the study.
4. At baseline TTE LVEF\>45%
5. Willing and able to give informed consent.

Exclusion Criteria:

1. Serum potassium level of more than 5.5 mmol/L
2. Acute myocardial infarction or cerebrovascular accident in the previous 6 months.
3. Severe uncontrolled hypertension (diastolic BP \>100mmHg or systolic BP \>160 mmHg)
4. Evidence or suspicion of renovascular disease.
5. Atrial fibrillation
6. Evidence or suspicion of collagen disease, cancer, psychiatric disorder that interferes with patient compliance, drug or alcohol abuse, pregnancy, breast feeding and ineffective contraception.
B: Inclusion Criteria:

* Women aged 18-70 years
* Eastern Cooperative Oncology Group (ECOG) performance status 0-1
* Serum creatinine \< 140 μmol/L or estimated creatinine clearance \> 60 ml/min (using the modification of diet and renal disease (MDRD) formula)
* Systolic blood pressure \>= 110 mgHg and \< 170 mmHg
* LVEF \>= 50%

Exclusion Criteria:

* Hypotension, defined as systolic blood pressure \< 110 mmHg
* Bradycardia, defined as heart rate \< 50 b.p.m.
* Prior anthracycline chemotherapy regimen
* Prior malignancy requiring chemotherapy or radiotherapy
* Symptomatic heart failure
* Systolic dysfunction (LVEF \< 50%)
* Clinically significant coronary artery disease, valvular heart disease, significant arrhythmias, or conduction delays.
* Uncontrolled arterial hypertension defined as systolic blood pressure \> 170 mm Hg
* Treatment with ACEI, ARB or beta-blocker within the last 4 weeks prior to study start
* Intolerance to ACEI, ARB or beta-blocker
* Uncontrolled concomitant serious illness
* Pregnancy or breastfeeding
* Active abuse of drugs or alcohol
* Suspected poor compliance
* Inability to tolerate the MRI scanning protocol
C: Inclusion Criteria:

* Age \> 18 years.
* Recipients of a first or a second renal transplant alone or in combination with a pancreas transplantation.
* Informed consent
* Adequate baseline biopsy; at least 10 cortical projection fields.

Exclusion Criteria:

* Age \< 18 years.
* Serum creatinine 2.5mg/dL.
* Persistent hyperkalemia; potassium \> 5.4 mEq/L.
* Known hypersensitivity to losartan or iodine allergy.
* Documented renal artery stenosis by duplex ultrasonography.
* Recipients of grafts from an HLA-identical sibling.
* Recipients whose primary renal disease is primary hyperoxaluria,dense-deposit disease, focal segmental glomerulosclerosis or hemolytic uremic syndrome.
* Women of childbearing age who wish to become pregnant and/or are unwilling to use contraceptive measures or who are pregnant.
* Recipients requiring ACE inhibitors or AII blockers for a cardiovascular indication (e.g. systolic dysfunction).
* Recipients who are \> 55 years old and had a history of cardiovascular disease (coronary artery disease, stroke or peripheral vascular disease).
D: Inclusion Criteria:

1. Undergoing elective valvular heart surgery, coronary artery bypass grafting
2. If female, must be postmenopausal for at least 1 year, status-post surgical sterilization, or if of childbearing potential, utilizing adequate birth control and willing to undergo urine beta-hcg testing prior to drug treatment and throughout the study

Exclusion Criteria

1. History of AF other than remote paroxysmal AF
2. Ejection fraction less than 30%
3. Evidence of coagulopathy (INR greater than 1.7 without warfarin therapy)
4. Emergency surgery
5. History of ACE inhibitor-induced angioedema
6. Low blood pressure (systolic blood pressure less than 100 mmHg and evidence of hypoperfusion)
7. Hyperkalemia (potassium level greater than 5.0 milliequivalents (mEq)/L at study entry)
8. Impaired kidney function (serum creatinine level greater than 1.6 mg/dl)
9. Any underlying or acute disease requiring regular medication that could possibly cause complications or make implementation of the study or interpretation of the study results difficult
10. Inability to discontinue current ACE inhibitor, AT1 receptor antagonist, or aldosterone receptor antagonist therapy
11. History of alcohol or drug abuse
12. Treatment with any investigational drug in the month prior to study entry
13. Mental condition that makes it impossible to understand the nature, scope and possible consequences of the study
14. Inability to comply with the study procedures (e.g., uncooperative attitude, inability to return for follow-up visits, and unlikelihood of completing the study)
15. Pregnant or breastfeeding

Answer: D