| Risk factors of cyclosporine nephrotoxicity after conversion from Sandimmune to Neoral. | |
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MedLine Citation:
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PMID: 11269679 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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Title: Clinical nephrology Volume: 55 ISSN: 0301-0430 ISO Abbreviation: Clin. Nephrol. Publication Date: 2001 Feb |
Date Detail:
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Created Date: 2001-03-27 Completed Date: 2001-06-14 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0364441 Medline TA: Clin Nephrol Country: Germany |
Other Details:
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Languages: eng Pagination: 149-55 Citation Subset: IM |
Affiliation:
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Department of Nephrology, Leiden University Medical Center, The Netherlands. yvosijp@knmg.nl |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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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:
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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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