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A Low Tacrolimus Concentration/Dose Ratio Increases the Risk for the Development of Acute Calcineurin Inhibitor-Induced Nephrotoxicity

Fast tacrolimus metabolism is linked to inferior outcomes such as rejection and lower renal function after kidney transplantation. Renal calcineurin-inhibitor toxicity is a common adverse effect of tacrolimus therapy. The present contribution hypothesized that tacrolimus-induced nephrotoxicity is re...

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Autores principales: Thölking, Gerold, Schütte-Nütgen, Katharina, Schmitz, Julia, Rovas, Alexandros, Dahmen, Maximilian, Bautz, Joachim, Jehn, Ulrich, Pavenstädt, Hermann, Heitplatz, Barbara, Van Marck, Veerle, Suwelack, Barbara, Reuter, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832469/
https://www.ncbi.nlm.nih.gov/pubmed/31581670
http://dx.doi.org/10.3390/jcm8101586
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author Thölking, Gerold
Schütte-Nütgen, Katharina
Schmitz, Julia
Rovas, Alexandros
Dahmen, Maximilian
Bautz, Joachim
Jehn, Ulrich
Pavenstädt, Hermann
Heitplatz, Barbara
Van Marck, Veerle
Suwelack, Barbara
Reuter, Stefan
author_facet Thölking, Gerold
Schütte-Nütgen, Katharina
Schmitz, Julia
Rovas, Alexandros
Dahmen, Maximilian
Bautz, Joachim
Jehn, Ulrich
Pavenstädt, Hermann
Heitplatz, Barbara
Van Marck, Veerle
Suwelack, Barbara
Reuter, Stefan
author_sort Thölking, Gerold
collection PubMed
description Fast tacrolimus metabolism is linked to inferior outcomes such as rejection and lower renal function after kidney transplantation. Renal calcineurin-inhibitor toxicity is a common adverse effect of tacrolimus therapy. The present contribution hypothesized that tacrolimus-induced nephrotoxicity is related to a low concentration/dose (C/D) ratio. We analyzed renal tubular epithelial cell cultures and 55 consecutive kidney transplant biopsy samples with tacrolimus-induced toxicity, the C/D ratio, C0, C2, and C4 Tac levels, pulse wave velocity analyses, and sublingual endothelial glycocalyx dimensions in the selected kidney transplant patients. A low C/D ratio (C/D ratio < 1.05 ng/mL×1/mg) was linked with higher C2 tacrolimus blood concentrations (19.2 ± 8.7 µg/L vs. 12.2 ± 5.2 µg/L respectively; p = 0.001) and higher degrees of nephrotoxicity despite comparable trough levels (6.3 ± 2.4 µg/L vs. 6.6 ± 2.2 µg/L respectively; p = 0.669). However, the tacrolimus metabolism rate did not affect the pulse wave velocity or glycocalyx in patients. In renal tubular epithelial cells exposed to tacrolimus according to a fast metabolism pharmacokinetic profile it led to reduced viability and increased Fn14 expression. We conclude from our data that the C/D ratio may be an appropriate tool for identifying patients at risk of developing calcineurin-inhibitor toxicity.
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spelling pubmed-68324692019-11-25 A Low Tacrolimus Concentration/Dose Ratio Increases the Risk for the Development of Acute Calcineurin Inhibitor-Induced Nephrotoxicity Thölking, Gerold Schütte-Nütgen, Katharina Schmitz, Julia Rovas, Alexandros Dahmen, Maximilian Bautz, Joachim Jehn, Ulrich Pavenstädt, Hermann Heitplatz, Barbara Van Marck, Veerle Suwelack, Barbara Reuter, Stefan J Clin Med Article Fast tacrolimus metabolism is linked to inferior outcomes such as rejection and lower renal function after kidney transplantation. Renal calcineurin-inhibitor toxicity is a common adverse effect of tacrolimus therapy. The present contribution hypothesized that tacrolimus-induced nephrotoxicity is related to a low concentration/dose (C/D) ratio. We analyzed renal tubular epithelial cell cultures and 55 consecutive kidney transplant biopsy samples with tacrolimus-induced toxicity, the C/D ratio, C0, C2, and C4 Tac levels, pulse wave velocity analyses, and sublingual endothelial glycocalyx dimensions in the selected kidney transplant patients. A low C/D ratio (C/D ratio < 1.05 ng/mL×1/mg) was linked with higher C2 tacrolimus blood concentrations (19.2 ± 8.7 µg/L vs. 12.2 ± 5.2 µg/L respectively; p = 0.001) and higher degrees of nephrotoxicity despite comparable trough levels (6.3 ± 2.4 µg/L vs. 6.6 ± 2.2 µg/L respectively; p = 0.669). However, the tacrolimus metabolism rate did not affect the pulse wave velocity or glycocalyx in patients. In renal tubular epithelial cells exposed to tacrolimus according to a fast metabolism pharmacokinetic profile it led to reduced viability and increased Fn14 expression. We conclude from our data that the C/D ratio may be an appropriate tool for identifying patients at risk of developing calcineurin-inhibitor toxicity. MDPI 2019-10-02 /pmc/articles/PMC6832469/ /pubmed/31581670 http://dx.doi.org/10.3390/jcm8101586 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Thölking, Gerold
Schütte-Nütgen, Katharina
Schmitz, Julia
Rovas, Alexandros
Dahmen, Maximilian
Bautz, Joachim
Jehn, Ulrich
Pavenstädt, Hermann
Heitplatz, Barbara
Van Marck, Veerle
Suwelack, Barbara
Reuter, Stefan
A Low Tacrolimus Concentration/Dose Ratio Increases the Risk for the Development of Acute Calcineurin Inhibitor-Induced Nephrotoxicity
title A Low Tacrolimus Concentration/Dose Ratio Increases the Risk for the Development of Acute Calcineurin Inhibitor-Induced Nephrotoxicity
title_full A Low Tacrolimus Concentration/Dose Ratio Increases the Risk for the Development of Acute Calcineurin Inhibitor-Induced Nephrotoxicity
title_fullStr A Low Tacrolimus Concentration/Dose Ratio Increases the Risk for the Development of Acute Calcineurin Inhibitor-Induced Nephrotoxicity
title_full_unstemmed A Low Tacrolimus Concentration/Dose Ratio Increases the Risk for the Development of Acute Calcineurin Inhibitor-Induced Nephrotoxicity
title_short A Low Tacrolimus Concentration/Dose Ratio Increases the Risk for the Development of Acute Calcineurin Inhibitor-Induced Nephrotoxicity
title_sort low tacrolimus concentration/dose ratio increases the risk for the development of acute calcineurin inhibitor-induced nephrotoxicity
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832469/
https://www.ncbi.nlm.nih.gov/pubmed/31581670
http://dx.doi.org/10.3390/jcm8101586
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