Document Detail


Effect of different immunosuppressive regimens on the evolution of distinct metabolic parameters: evidence from the Symphony study.
MedLine Citation:
PMID:  21617197     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The metabolic syndrome (MS) is an important risk factor for graft dysfunction and patient death after renal transplantation. The aim of this sub-analysis of the Symphony study was to assess the progression of the laboratory parameters associated with MS in the first year after transplantation.
METHODS: Data collected from the Symphony study were used; 1645 patients were randomized to receive standard-dose cyclosporine (Stand-CsA), low-dose cyclosporine (Low-CsA), tacrolimus (Low-Tac) or sirolimus (Low-SRL), in addition to mycophenolate mofetil (MMF) and corticosteroids. Data were collected for levels and progression over the first year post-transplantation of systolic and diastolic blood pressure, uric acid, triglycerides, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and fasting glucose levels by treatment arm.
RESULTS: The low-SRL group had significantly higher levels of triglycerides and LDL. The two CsA arms were associated with the highest uric acid levels at each time point. There were no significant differences in overall levels or changes in glucose or HDL. Patients in the standard-CsA arm had significantly higher diastolic blood pressure than those in the Low-SRL and Low-Tac arms. Systolic blood pressure was higher in the Low-CsA arm than in the Low-Tac arm. The use of antihypertensive and antidiabetic agents was similar between the treatment arms. In the Low-SRL arm, more patients were treated with lipid-lowering therapy. Mean daily steroid doses were the highest in the Low-SRL arm.
CONCLUSIONS: This sub-analysis demonstrates that there is a difference in metabolic parameters between immunosuppressive groups. CsA therapy was associated with the highest values of uric acid and systolic and diastolic blood pressure. Patients on SRL therapy had the worst lipaemic control. A possible effect of Tac on new-onset diabetes could not be excluded.
Authors:
Kathleen Claes; Herwig-Ulf Meier-Kriesche; Jesse D Schold; Yves Vanrenterghem; Philip F Halloran; Henrik Ekberg
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-05-26
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  27     ISSN:  1460-2385     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-10     Completed Date:  2012-09-13     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  850-7     Citation Subset:  IM    
Affiliation:
Department of Nephrology and Renal Transplantation, University Hospital Gasthuisberg, Leuven, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / administration & dosage,  adverse effects
Adult
Blood Chemical Analysis
Blood Pressure Determination
Body Mass Index
Cyclosporine / administration & dosage,  adverse effects
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Female
Graft Rejection
Graft Survival
Humans
Hyperlipidemias / diagnosis,  epidemiology
Immunosuppressive Agents / administration & dosage*
Kidney Failure, Chronic / diagnosis,  surgery*
Kidney Transplantation / adverse effects*,  immunology,  methods
Male
Metabolic Syndrome X / etiology*,  physiopathology
Middle Aged
Monitoring, Physiologic / methods
Mycophenolic Acid / administration & dosage,  adverse effects,  analogs & derivatives
Prognosis
Reference Values
Risk Assessment
Sirolimus / administration & dosage,  adverse effects
Tacrolimus / administration & dosage,  adverse effects
Transplantation Immunology*
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Immunosuppressive Agents; 109581-93-3/Tacrolimus; 24280-93-1/Mycophenolic Acid; 53123-88-9/Sirolimus; 59865-13-3/Cyclosporine; 9242ECW6R0/mycophenolate mofetil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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