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.
Department of Surgery, University of Texas Medical School, Houston 77030.
R
R
Lewis
J
J
Podbielski
S
S
Sprayberry
M
M
Munsell
S
S
Katz
M
M
Rubin
P
P
Kimball
C T
CT
Van Buren
R
R
Kerman
B
B
Kahan
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