Stability of renal allograft glomerular filtration rate associated with long-term use of cyclosporine A.
Renal allograft glomerular filtration rate (GFR) was measured at 4-month intervals for up to 1 year in 43 CsA-treated patients using x-ray fluorescence determination of plasma iohexol clearance. Study patients were divided into cohorts based on time (years) after transplantation at study entry (0-1; 1-2; 2-3; and > 3 years) and entry GFR levels (20-29; 30-39; 40-49; and > or = 50 ml/min/1.73 m2). GFR at study entry was 42 +/- 2 and was comparable in CAD (n = 31) versus LRD (n = 12) allografts (42 +/- 2 and 44 +/- 4 ml/min/1.73 m2, respectively). Range of entry GFR levels was similar in each of the "time at entry" cohorts defined above. Serum creatinine concentrations of 1.5-2.5 mg% were associated with GFR levels of 20-60 ml/min/1.73 m2. Serial GFR levels obtained at 4-month intervals for 1 year (n = 34 patients) were not consistent with a pattern of progressively declining GFR occurring as a function of either time after transplantation or absolute GFR level at study entry (intraindividual coefficient of variation 10.3 +/- 1.0%). Patients in the lower quartile of "entry GFR" levels (< 34 ml/min/1.73 m2) were more likely than their counterparts to have had a history of acute rejection. Results are consistent with retrospective population studies of aggregate serum creatinine levels, indicating that long-term CsA use is not uniformly associated with accelerated loss of renal allograft function consequent to a progressive, toxic nephropathy. The data also suggest that neither absolute GFR level nor time after transplantation represent indications for routine dose reduction or conversion to AZA.
Lewis
R
R
Department of Surgery, University of Texas Medical School, Houston 77030.
Podbielski
J
J
Sprayberry
S
S
Munsell
M
M
Katz
S
S
Rubin
M
M
Kimball
P
P
Van Buren
C T
CT
Kerman
R
R
Kahan
B
B
D000328:Adult; D000368:Aged; D002102:Cadaver; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000494:pharmacology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007472:Iohexol / Q000493:pharmacokinetics; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013052:Spectrometry, X-Ray Emission; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000502:physiology
D007472:Iohexol; D016572:Cyclosporine; D003404:Creatinine