Document Detail

Impact of Late Calcineurin Inhibitor Withdrawal on Ambulatory Blood Pressure and Carotid Intima Media Thickness in Renal Transplant Recipients.
MedLine Citation:
PMID:  23715049     Owner:  NLM     Status:  Publisher    
BACKGROUND: Calcineurin inhibitors (CNIs) have an unfavorable cardiovascular risk profile in renal transplant recipients. The aim of this substudy was to assess the effects of late CNI or mycophenolate mofetil (MMF) withdrawal on ambulatory blood pressure monitoring and carotid intima media thickness. METHODS: A total of 119 stable renal transplant recipients on triple regimen with steroids, a CNI and MMF were randomized into either the concentration-controlled CNI or MMF withdrawal groups. Patients were treated for traditional cardiovascular risk factors according to predefined targets. Ambulatory blood pressure monitoring and measurements of intima media thickness were performed at baseline and after 1, 2, and 3 years after randomization. RESULTS: CNI withdrawal resulted in a significant decline in both ambulatory day- and nighttime blood pressures (daytime: systolic blood pressure, -1.6 mm Hg/y, P=0.018; diastolic blood pressure, -1.3 mm Hg/y, P=0.002; nighttime systolic blood pressure: -1.9 mm Hg/y, P=0.008; diastolic blood pressure: -1.3 mm Hg/y, P=0.014), which was not observed after MMF withdrawal. There was no difference in the proportion of nocturnal nondippers (both groups, 69%, P=0.95). Despite the reduction in ambulatory blood pressure, no effect of CNI withdrawal on carotid intima media thickness was found. CONCLUSION: In stable renal transplant recipients, late CNI withdrawal from a triple drug regimen decreased blood pressure in comparison with MMF withdrawal but had no specific impact on carotid intima media thickness. Considering the high prevalence of hypertension in patients on CNI therapy, most stable renal transplant recipients may benefit from late CNI withdrawal by improved blood pressure control.
Jacqueline S Mourer; Eelco J P de Koning; Erik W van Zwet; Marko J K Mallat; Ton J Rabelink; Johan W de Fijter
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-5-24
Journal Detail:
Title:  Transplantation     Volume:  -     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-5-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 Department of Nephrology, Leiden University Medical Centre, Leiden, The Netherlands. 2 Department of Medical Statistics and Bioinformatics, University Medical Centre, Leiden, The Netherlands. 3 Address correspondence to: Johan W. de Fijter, M.D., Ph.D., Department of Nephrology, C3-P22, Leiden University Medical Centre, P.O. Box 9600, NL-2300 RC Leiden, The Netherlands.
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