Document Detail


Risk factors of cyclosporine nephrotoxicity after conversion from Sandimmune to Neoral.
MedLine Citation:
PMID:  11269679     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In 1995 - 1996, we switched from a once-daily Sandimmune dose to a twice-daily dose regimen of Neoral. Concurrent with the switch we changed our target trough level from 100 microg/l at 24 hours to the generally accepted 12-hour level of 150 microg/l. We performed a retrospective cohort study to assess cyclosporine toxicity following this switch and to identify risk factors for nephrotoxicity. PATIENTS AND METHODS: Of 212 patients with a stable graft function pre-conversion clinical parameters at 1 and 12 months post-conversion were compared with those at time of conversion. Cyclosporine nephrotoxicity was defined as a significant decline of the reciprocal of the serum creatinine concentration over time post-conversion in the absence of other obvious causes for declining graft function. Risk factors of cyclosporine nephrotoxicity were assessed using logistic regression analysis. RESULTS: The mean cyclosporine trough level rose from 87 microg/l at the time of conversion to 139 microg/l at 12 months post-conversion whereas the daily drug dose increased over the same period from 233 mg to 252 mg. Mean serum creatinine increased by 10% from 135 to 148 micromol/l (p < 0.001). Cyclosporine nephrotoxicity was present in 42 patients (20%). Cyclosporine dose and trough level did not predict nephrotoxicity but beta-blockers (OR 0.35, 95% CI 0.17-0.72) and calcium channel blockers (OR 0.35, 95% CI 0.19-0.82) reduced the risk of nephrotoxicity, independent from an effect on blood pressure. CONCLUSION: 20% of stable renal transplant patients experienced chronic cyclosporine nephrotoxicity after conversion from a once-daily Sandimmune regimen to a twice-daily Neoral regimen with dose adjustments to a trough level of 150 microg/l. beta-blockers and calcium channel blockers reduced the risk of nephrotoxicity.
Authors:
Y W Sijpkens; M J Mallat; C E Siegert; A H Zwinderman; R G Westendorp; J W de Fijter; L A van Es; L C Paul
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical nephrology     Volume:  55     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-03-27     Completed Date:  2001-06-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  149-55     Citation Subset:  IM    
Affiliation:
Department of Nephrology, Leiden University Medical Center, The Netherlands. yvosijp@knmg.nl
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / administration & dosage
Calcium Channel Blockers / administration & dosage
Creatinine / blood
Cyclosporine / administration & dosage,  adverse effects*,  pharmacokinetics
Female
Humans
Immunosuppressive Agents / administration & dosage,  adverse effects*,  pharmacokinetics
Kidney Diseases / chemically induced*
Kidney Transplantation*
Logistic Models
Male
Middle Aged
Retrospective Studies
Risk Factors
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Calcium Channel Blockers; 0/Immunosuppressive Agents; 59865-13-3/Cyclosporine; 60-27-5/Creatinine

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


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