Untitled

Abstract

Objectives: Cardiovascular disease is a common cause of morbidity and mortality in patients with chronic kidney failure, before and after a kidney transplant. Oxidation of lipoproteins that contain apolipoprotein B may contribute to the initiation of atherosclerosis. Paraoxonase may prevent cardiovascular disease. We compared the effects of different calcineurin inhibitors on risk factors for cardiovascular disease in kidney transplant recipients. Materials and Methods: In 16 kidney transplant recipients, treatment included tacrolimus in 8 patients and cyclosporine in 8 patients. Hemoglobin, glucose, renal function, lipid parameters, high-sensitivity C-reactive protein, homocysteine, malondialdehyde, paraoxonase activity, and arylesterase activity were measured before transplant and at 1, 6, and 12 months after the transplant. Results: The levels of homocysteine and malondialdehyde did not change significantly in patients who received either tacrolimus or cyclosporine. The high-sensitivity C-reactive protein was decreased (tacrolimus group, 1 mo) and increased (cyclosporine group, 6 and 12 mo) after the kidney transplant. Paraoxonase activity was increased (tacrolimus group, 1 mo). Arylesterase activity was increased (tacrolimus group, 1, 6, and 12 mo; cyclosporine group, 1 and 6 mo). The percentage of change in arylesterase activity was higher at 12 months in the tacrolimus than in the cyclosporine group. Conclusions: Tacrolimus may be more effective than cyclosporine in improving risk factors for cardiovascular disease after kidney transplant.

The importance of paraoxonase 1 activity in chronic kidney disease

“…It has been shown that erythropoietin β and iron treatment has a beneficial effect on the levels of antibodies against oxidized LDL and on serum PON1 activity in pre dialysis patients with chronic renal disease and anemia [ 76 ]. Immunosuppressive drugs and especially the calcineurin inhibitor tacrolimus, may be more effective than cyclosporine as regards paraoxonase and arylesterase activities in CKD patients before and after 12 months of kidney transplant (KT) [ 77 ]. The modulating effect of hydroxymethyl glutaryl-coenzyme A (HMG-CoA) inhibitors (statins) on PON1 activity in type 2 diabetic nephropathy (T2DN) patients was investigated as well [ 68–70 ].…”

The Increase in Paraoxonase 1 Is Associated With Decrease in Left Ventricular Volume in Kidney Transplant Recipients

“…This gradient in PON1 enzymatic activity is consistent with the gradient of kidney function. However, all studies have been cross-sectional in nature, with the exception of a study comparing change in arylesterase at 1, 6 and 12 months post-transplant ( 10 ). There has been no prospective determination of change in PON1 mass and activity with prospective restoration of kidney function through KT.…”