Study of the cyclosporine concentration at 2 hours in stable renal transplant patients and relation to body mass index

Hortal, L; Fernandez, Armida; Losada, Antonio; Lorenzo, Michele; Baamonde, Eduardo; Plaza, C; Gallego, Román Hernández; Vega, N; Palop, L

doi:10.1016/s0041-1345(01)02326-0

Cited by 15 publications

(8 citation statements)

References 5 publications

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“…In most studies, patients with a higher BMI have been found to require less cyclosporine to maintain therapeutic trough levels [19] , [20] , [21] . However, other studies have found the opposite results [22] . The current study showed that BMI level is not related to tacrolimus concentrations.…”

Section: Discussionmentioning

confidence: 92%

Pharmacokinetics of tacrolimus according to body composition in recipients of kidney transplants

Han

Kim

Lee

et al. 2012

Kidney Research and Clinical Practice

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BackgroundCurrently, the dosage of tacrolimus used after transplantation is based on the patient's body weight. However, there is a low correlation between body weight and body composition in kidney transplant recipients. In this study, we evaluate the pharmacokinetics of tacrolimus according to body composition in 18 Korean kidney transplant recipients with stable graft function.MethodsBody composition parameters were calculated using bioelectrical impedance analysis. Pharmacokinetic profiles were determined 0, 1, 2, 3, and 4 hours after treatment with tacrolimus and were compared between high- and low-level median body composition groups. The values of C0, C1, C2, C3, and C4 were used in determining an abbreviated area under the curve (AUC) for tacrolimus.ResultsThe mean body mass index (BMI) and body composition values were as follows: BMI, 24.3 kg/m2; lean mass, 49.8 kg; and fat mass, 17.4 kg. There were no statistical differences in pharmacokinetic profiles between groups with different BMIs. However, the C0 and C4 in the high-fat group were significantly elevated compared with those of the low-fat group (P=0.024 and 0.031, respectively). Furthermore, the C0, C2, C3, and C4 and the AUC were significantly different between the two lean mass groups (P=0.007, 0.038, 0.047, 0.015, and 0.015, respectively). Other variables, such as waist circumference and arm muscle circumference, did not differentiate between the pharmacokinetic profiles of tacrolimus.ConclusionTaken together, these data suggest that tacrolimus dose monitoring based on body composition may provide adequate dosage leading to favorable long-term outcomes.

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Section: Discussionmentioning

confidence: 92%

Pharmacokinetics of tacrolimus according to body composition in recipients of kidney transplants

Han

Kim

Lee

et al. 2012

Kidney Research and Clinical Practice

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“…Subsequently, it was noted that patients with a higher body mass index required less cyclosporine in relation to their body weight to maintain therapeutic levels (28). However, cyclosporine concentrations at 2 h after drug intake (C 2 ) were lower in obese patients despite achieving similar trough concentrations (29). A different immunosuppressant, FK‐506, has been found to be a risk factor for post‐transplant diabetes, particularly in obese KTR (17).…”

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein and Body Mass Index Independently Predict Mortality in Kidney Transplant Recipients

Winkelmayer

Lorenz

Kramar

et al. 2004

American Journal of Transplantation

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C-reactive protein (CRP) is a risk factor for cardiovascular outcomes and mortality in the general population.To date, there are no prospective studies of the association between CRP and mortality or allograft loss in kidney transplant recipients (KTR). In 1995, 438 consecutive KTR were enrolled in this prospective study. Important information on demographic, clinical and immunological characteristics was collected at baseline, and CRP was measured using standard methods. Patients were then followed-up for a median 7.8 years. Time-to-event analyses (univariate and multivariate Cox proportional hazards regression models) were used to study the main outcomes: all-cause mortality and kidney allograft loss, defined as the earlier of return to dialysis, re-transplantation, or death. From univariate analyses, we found that CRP ≥0.5 mg/dL was associated with a 83% greater mortality risk compared with lower levels of this inflammatory marker [hazard ratio (HR) = 1.83; 95% confidence interval (CI): 1.23-2.72; p = 0.003]. After multivariate adjustment, patients with a CRP ≥0.5 mg/dL had a 53% higher mortality risk compared with patients whose CRP was below that threshold (HR = 1.53; 95% CI: 1.01-2.31; p = 0.04). No associations between CRP and the risk of kidney allograft loss were detected. Furthermore, we were not able to detect any effect modification between CRP and body mass index on the outcomes under study. We conclude that CRP predicts all-cause mortality, but not allograft loss in stable KTR.

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“…Hortal et al . retrospectively determined the relationship between obesity and cyclosporine (CyA) concentrations in 28 patients, 14 of whom were obese 83 . They measured both trough CyA concentration (Co) and the concentration 2 h after administration (C2) and found that while Co was similar in both groups (149.6 ± 30.5 vs 158.2 ± 30.2 ng/mL, P = NS), C2 was significantly higher in the lean group (534.4 ± 137 vs 680 ± 179.7 ng/mL, P < 0.05).…”

Section: Pretransplant Obesity: Complications and Outcomesmentioning

confidence: 99%

“…82 Hortal et al retrospectively determined the relationship between obesity and cyclosporine (CyA) concentrations in 28 patients, 14 of whom were obese. 83 They measured both trough CyA concentration (Co) and the concentration 2 h after administration (C2) and found that while Co was similar in both groups (149.6 ± 30.5 vs 158.2 ± 30.2 ng/mL, P = NS), C2 was significantly higher in the lean group (534.4 ± 137 vs 680 ± 179.7 ng/mL, P < 0.05). They concluded that adherence to managing Co levels close to 150 ng/mL, once the patient had been stabilized, resulted in lower C2 levels in obese RTR, which may in turn be a factor contributing to poorer long-term graft survival in these patients (although the clinical value of C2 levels remains speculative).…”

Section: Obesity and Attainment Of Therapeutic Immunosuppression Levelsmentioning

confidence: 99%

Impact of obesity on renal transplant outcomes

et al. 2005

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SUMMARY:Obesity is a frequent and important consideration to be taken into account when assessing patient suitability for renal transplantation. In addition, posttransplant obesity continues to represent a significant challenge to health care professionals caring for renal transplant recipients. Despite the vast amount of evidence that exists on the effect of pretransplant obesity on renal transplant outcomes, there are still conflicting views regarding whether obese renal transplant recipients have a worse outcome, in terms of short-and long-term graft survival and patient survival, compared with their non-obese counterparts. It is well established that any association of obesity with reduced patient survival in renal transplant recipients is mediated in part by its clustering with traditional cardiovascular risk factors such as hypertension, dyslipidaemia, insulin resistance and posttransplant diabetes mellitus, but what is not understood is what mediates the association of obesity with graft failure. Whether it is the higher incidence of cardiovascular comorbidities jeopardising the graft or factors specific to obesity, such as hyperfiltration and glomerulopathy, that might be implicated, currently remains unknown. It can be concluded, however, that pre-and posttransplant obesity should be targeted as aggressively as the more well-established cardiovascular risk factors in order to optimize long-term renal transplant outcomes. KEY WORDS: cardiovascular risk factors, graft function, obesity, renal transplant recipients, transplant outcomes.The World Health Organization (WHO) classification of obesity is determined by the body mass index (BMI), which is defined as weight in kilograms (kg) divided by height in metres squared (m 2 ). Using this calculation, a BMI of 18.5-24.9 kg/m 2 represents normal weight, a BMI of 25-29.9 kg/m 2 represents overweight, and a BMI greater than 30 kg/m 2 represents obesity.

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Study of the cyclosporine concentration at 2 hours in stable renal transplant patients and relation to body mass index

Cited by 15 publications

References 5 publications

Pharmacokinetics of tacrolimus according to body composition in recipients of kidney transplants

Pharmacokinetics of tacrolimus according to body composition in recipients of kidney transplants

C-Reactive Protein and Body Mass Index Independently Predict Mortality in Kidney Transplant Recipients

Impact of obesity on renal transplant outcomes

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