title: Effect of nitrendipine on renal function in renal-transplant patients treated with cyclosporin: a randomised trial.
abstract: BACKGROUND
  Calcium antagonists such as nitrendipine reduce the effects of cyclosporin on renal haemodynamics, however, their long-term efficacy has not been established. We did a randomised trial to investigate the effects of nitrendipine on renal function in renal-transplant patients treated with cyclosporin.
  
  
  METHODS
  253 renal-transplant patients were recruited: 52 normotensive patients (diastolic blood pressure <90 mm Hg) were assigned placebo and 57 nitrendipine 5 mg twice daily; 71 hypertensive patients (diastolic blood pressure >90 to <115 mm Hg) were assigned placebo and 73 nitrendipine 10 mg twice daily. Nitrendipine was increased to 20 mg twice daily if the target diastolic blood pressure (<90 mm Hg) was not achieved. The patients were seen once a month for 24 months; blood pressure and serum creatinine concentration were recorded at each visit. Analysis was by intention to treat.
  
  
  RESULTS
  63 patients were withdrawn (35 nitrendipine, 28 placebo). The mean serum creatinine concentration at baseline was slightly higher in the nitrendipine group (146.7 micromol/L [SE 4.42]) than in the placebo group (137.0 micromol/L [3.54]. At the 24-month endpoint or at dropout, serum creatinine concentration was significantly higher in the 123 patients in the placebo group than the 130 patients in the nitrendipine group (160.8 [7.1] vs 148.5 [5.3], p for effect of treatment=0.025, analysis of covariance in a two-way classification; 95% CI for difference -1.77 to -22.98). At study entry, the blood pressures of the placebo and the nitrendipine groups were almost identical. At 24 months, blood pressure was higher in the normotensive patients given a placebo than in those patients given nitrendipine. By contrast, blood-pressure values were similar in those hypertensive patients given a placebo and those given nitrendipine at the end of treatment.
  
  
  CONCLUSIONS
  The calcium antagonist nitrendipine has no adverse effects on kidney function in renal-transplant patients with cyclosporin. The drug has a small but significant nephroprotective effect, that is independent of the drug's antihypertensive action.
authors.affiliation: Department of Medicine, University of Muenster, Germany. rahn@uni-muenster.de
authors.forename: K H
authors.initials: KH
authors.lastname: Rahn
authors.forename: M
authors.initials: M
authors.lastname: Barenbrock
authors.forename: E
authors.initials: E
authors.lastname: Fritschka
authors.forename: A
authors.initials: A
authors.lastname: Heinecke
authors.forename: J
authors.initials: J
authors.lastname: Lippert
authors.forename: K
authors.initials: K
authors.lastname: Schroeder
authors.forename: I
authors.initials: I
authors.lastname: Hauser
authors.forename: K
authors.initials: K
authors.lastname: Wagner
authors.forename: H H
authors.initials: HH
authors.lastname: Neumayer
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008875:Middle Aged; D009568:Nitrendipine / Q000494:pharmacology / Q000627:therapeutic use*; D018709:Statistics, Nonparametric
chemical_list: D002121:Calcium Channel Blockers; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009568:Nitrendipine; D003404:Creatinine