Please use this identifier to cite or link to this item: http://ir.swu.ac.th/jspui/handle/123456789/14989
Title: Sirolimus Attenuates the Rate of Progression of Early Chronic Allograft Nephropathy
Authors: Sumethkul V.
Changsirikulchai S.
Lothuvachai T.
Chalermsanyakorn P.
Keywords: azathioprine
cyclosporin A
dipeptidyl carboxypeptidase inhibitor
hydroxymethylglutaryl coenzyme A reductase inhibitor
mycophenolic acid 2 morpholinoethyl ester
prednisolone
rapamycin
adult
article
attenuation
blood pressure
chronic allograft nephropathy
clinical article
clinical trial
controlled clinical trial
controlled study
demography
disease course
drug blood level
follow up
glomerulus filtration rate
high performance liquid chromatography
human
kidney biopsy
linear regression analysis
prescription
priority journal
rank sum test
rating scale
statistical analysis
statistical significance
Adult
Azathioprine
Biopsy
Blood Pressure
Chronic Disease
Creatinine
Cyclosporine
Disease Progression
Drug Therapy, Combination
Glomerular Filtration Rate
Humans
Immunosuppressive Agents
Kidney Function Tests
Kidney Transplantation
Middle Aged
Mycophenolic Acid
Postoperative Complications
Sirolimus
Transplantation, Homologous
Treatment Outcome
Issue Date: 2006
Abstract: Optimal treatment for patients with chronic allograft nephropathy (CAN) is not known. Early intervention is preferred. We examined the benefit of adding sirolimus (SRL; C0 5-12 ng/mL: HPLC) on the rate of progression of early CAN. We identified patients with biopsy-confirmed Banff grade 1 CAN. After biopsy, patients were switched to SRL + CsA + prednisolone (SRL), MMF + CsA + prednisolone (MMF), or CsA + AZA + prednisolone (AZA). GFR was estimated by Cockcroft-Gault and MDRD formulae. The rate of GFR decline (delta GFR) was determined by calculating the slope of the regression line of estimated GFR (MDRD and Cockcroft-Gault method) at different times. Statistical analysis was performed by the Wilcoxon test. The 41 patients with CAN grade 1 were assigned to SRL: MMF: AZA = 12: 20: 9. Before biopsy; the graft age for SRL: MMF: AZA were 56 ± 27: 70 ± 48: 51 ± 36 months; and the GFR (MDRD method), 38 ± 8: 42 ± 15: 36 ± 14 mL/min; GFR (C-G method) 45 ± 13, 42 ± 12, 41 ± 15 mL/min; trough CsA levels 152 ± 36: 145 ± 46: 177 ± 61 ng/dL; delta GFR (MDRD method) -0.18 ± 0.20: -0.15 ± 0.59: -0.20 ± 1.08; delta GFR (C-G method) -0.13 ± 0.37: -0.19 ± 0.24: -0.65 ± 0.99. Follow-up time for SRL: MMF: AZA was 19 ± 4: 35 ± 32: 59 ± 54 months. At last follow-up; GFR (MDRD method) for SRL: MMF: AZA were 39 ± 13: 35 ± 21: 40 ± 24 mL/min; GFR (C-G method) 46 ± 17, 37 ± 18, 46 ± 25 mL/min; BP 128 ± 11/79 ± 7: 131 ± 22/80 ± 14: 132 ± 20/82 ± 11 mm Hg; and CsA level 52 ± 25: 122 ± 41: 155 ± 49. After biopsy, statin was prescribed in nine SRL, 10 MMF, and three AZA. ACEI was prescribed in two SRL, three MMF, and two AZA. Compared with the prebiopsy values, the delta GFR (MDRD method) changed to -0.04 ± 0.31 (SRL; P = .04), -0.17 ± 0.40 (MMF; P = .60), and -0.97 ± 1.52 (AZA: P = .16). Delta GFR (C-G method) was also significantly improved in the SRL group (-0.02 ± 0.47; P = .05) but not in the MMF (-0.13 ± 0.51; P = .53) or AZA (-0.54 ± 1.78; P = .44). We concluded that patients with early CAN who are switched to SRL and low-dose CsA have a significant attenuation of the rate of GFR declination when compared with patients who receive MMF or AZA addition. © 2006 Elsevier Inc. All rights reserved.
URI: https://www.scopus.com/inward/record.uri?eid=2-s2.0-33845452280&doi=10.1016%2fj.transproceed.2006.10.097&partnerID=40&md5=68a6fc500623d77e93a18a64d8fae067
http://ir.swu.ac.th/jspui/handle/123456789/14989
ISSN: 411345
Appears in Collections:Scopus 1983-2021

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