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Fukui R, Noda S, Ikeda Y, Sawayama Y, Terada T, Nakagawa Y, Morita SY. Relationships of Proton Pump Inhibitor-Induced Renal Injury with CYP2C19 Polymorphism: A Retrospective Cohort Study. Clin Pharmacol Ther 2024; 115:1141-1151. [PMID: 38258325 DOI: 10.1002/cpt.3183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024]
Abstract
Proton pump inhibitors (PPIs) have recently been reported to be linked with nephrotoxicity. PPIs are metabolized mainly or partly by cytochrome P450 2C19 (CYP2C19). However, the relationship between CYP2C19 genetic polymorphism and PPI-induced nephrotoxicity is unclear. In this study, we aimed to analyze the association between the time of occurrence of renal injury by PPIs, including lansoprazole, esomeprazole, rabeprazole, and vonoprazan, and CYP2C19 metabolizer status classified by CYP2C19 genotypes. Patients prescribed PPIs were reviewed in this retrospective cohort study. The primary outcome was the time to a 30% decrease in estimated glomerular filtration rate (eGFR) from baseline. In patients treated with lansoprazole, the time to a 30% decrease in eGFR for the CYP2C19 poor metabolizer (PM) group was significantly shorter than that for the non-PM group (hazard ratio for PM vs. non-PM, 2.43, 95% confidence interval, 1.21 to 4.87, P = 0.012). In contrast, in patients that received esomeprazole, rabeprazole, or vonoprazan, no significant differences were found in the time to a 30% decrease in eGFR between non-PM and PM groups. The adjusted hazard ratios for the time to a 30% eGFR decrease in patients treated with lansoprazole were significantly higher for CYP2C19 PM, hypertension, and a history of myocardial infarction. In conclusion, this retrospective study showed that CYP2C19 metabolizer status was associated with the time to a 30% eGFR decrease in patients treated with lansoprazole, but not with esomeprazole, rabeprazole, or vonoprazan.
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Affiliation(s)
- Rika Fukui
- Department of Pharmacotherapeutics, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Satoshi Noda
- Department of Pharmacotherapeutics, Shiga University of Medical Science, Otsu, Shiga, Japan
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Yoshito Ikeda
- Department of Pharmacotherapeutics, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yuichi Sawayama
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
- Department of Cardiovascular Medicine, Kurashiki Center Hospital, Kurashiki, Okayama, Japan
| | - Tomohiro Terada
- Department of Pharmacotherapeutics, Shiga University of Medical Science, Otsu, Shiga, Japan
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shin-Ya Morita
- Department of Pharmacotherapeutics, Shiga University of Medical Science, Otsu, Shiga, Japan
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Satalkar V, Swamy KV. Pathophysiology of acute kidney injury on a molecular level: A brief review. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_161_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Tanaka T, Ihara M, Fukuma K, Yamamoto H, Washida K, Kimura S, Kada A, Miyata S, Miyata T, Nagatsuka K. Influence of Renal Impairment and Genetic Subtypes on Warfarin Control in Japanese Patients. Genes (Basel) 2021; 12:genes12101537. [PMID: 34680932 PMCID: PMC8535514 DOI: 10.3390/genes12101537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/21/2021] [Accepted: 09/25/2021] [Indexed: 11/16/2022] Open
Abstract
The genotypes of vitamin K epoxide reductase complex 1 (VKORC1) and cytochrome P450 2C9 (CYP2C9) can influence therapeutic warfarin doses. Conversely, nongenetic factors, especially renal function, are associated with warfarin maintenance doses; however, the optimal algorithm for considering genes and renal dysfunction has not been established. This single-center prospective cohort study aimed to evaluate the factors affecting warfarin maintenance doses and develop pharmacogenetics-guided algorithms, including the factors of renal impairment and others. To commence, 176 outpatients who were prescribed warfarin for thromboembolic stroke prophylaxis in the stroke center, were enrolled. Patient characteristics, blood test results, dietary vitamin K intake, and CYP2C9 and VKORC1 (-1639G>A) genotypes were recorded. CYP2C9 and VKORC1 (-1639G>A) genotyping revealed that 80% of the patients had CYP2C9 *1/*1 and VKORC1 mutant AA genotypes. Multiple linear regression analysis demonstrated that the optimal pharmacogenetics-based model comprised age, body surface area, estimated glomerular filtration rate (eGFR), genotypes, vitamin K intake, aspartate aminotransferase levels, and alcohol intake. eGFR exercised a significant impact on the maintenance doses, as an increase in eGFR of 10 mL/min/1.73 m2 escalated the warfarin maintenance dose by 0.6 mg. Reduced eGFR was related to lower warfarin maintenance doses, independent of VKORC1 and CYP2C9 genotypes in Japanese patients.
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Affiliation(s)
- Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan; (M.I.); (K.F.); (K.W.); (S.K.); (K.N.)
- Correspondence:
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan; (M.I.); (K.F.); (K.W.); (S.K.); (K.N.)
| | - Kazuki Fukuma
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan; (M.I.); (K.F.); (K.W.); (S.K.); (K.N.)
| | - Haruko Yamamoto
- Center for Advancing Clinical and Translational Sciences, National Cerebral and Cardiovascular Center, Suita, Osaka 564-8565, Japan;
| | - Kazuo Washida
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan; (M.I.); (K.F.); (K.W.); (S.K.); (K.N.)
| | - Shunsuke Kimura
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan; (M.I.); (K.F.); (K.W.); (S.K.); (K.N.)
| | - Akiko Kada
- Clinical Research and Development, National Cerebral and Cardiovascular Center, Suita, Osaka 564-8565, Japan;
| | - Shigeki Miyata
- Department of Clinical Laboratory Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka 564-8565, Japan;
| | - Toshiyuki Miyata
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka 564-8565, Japan;
| | - Kazuyuki Nagatsuka
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan; (M.I.); (K.F.); (K.W.); (S.K.); (K.N.)
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Ladda MA, Goralski KB. The Effects of CKD on Cytochrome P450-Mediated Drug Metabolism. Adv Chronic Kidney Dis 2016; 23:67-75. [PMID: 26979145 DOI: 10.1053/j.ackd.2015.10.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 12/20/2022]
Abstract
CKD affects a significant proportion of the world's population, and the prevalence of CKD is increasing. Standard practice currently is to adjust the dose of renally eliminated medications as kidney function declines in effort to prevent adverse drug reactions. It is increasingly becoming recognized that CKD also impacts nonrenal clearance mechanisms such as hepatic and intestinal cytochrome P450 (CYP) enzymes and drug transport proteins, the latter of which is beyond the scope of this review. CYPs are responsible for the metabolism of many clinically used drugs. Genetics, patient factors (eg, age and disease) and drug interactions are well known to affect CYP metabolism resulting in variable pharmacokinetics and responses to medications. There now exists an abundance of evidence demonstrating that CKD can impact the activity of many CYP isoforms either through direct inhibition by circulating uremic toxins and/or by reducing CYP gene expression. Evidence suggests that reductions in CYP metabolism in ESRD are reversed by kidney transplantation and temporarily restored via hemodialysis. This review summarizes the current understanding of the effects that CKD can have on CYP metabolism and also discusses the impact that CYP metabolism phenotypes can have on the development of kidney injury.
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Regnier-Rosencher E, Lazareth H, Gressier L, Avril M, Thervet E, Dupin N. Acute kidney injury in patients with severe rash on vemurafenib treatment for metastatic melanomas. Br J Dermatol 2013; 169:934-8. [DOI: 10.1111/bjd.12555] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2013] [Indexed: 01/14/2023]
Affiliation(s)
- E. Regnier-Rosencher
- Department of Dermatology; Hôpital Cochin; APHP; University René Descartes; Paris France
| | - H. Lazareth
- Department of Nephrology; Hôpital Européen Georges Pompidou; University René Descartes; Paris France
| | - L. Gressier
- Department of Dermatology; Hôpital Cochin; APHP; University René Descartes; Paris France
| | - M.F. Avril
- Department of Dermatology; Hôpital Cochin; APHP; University René Descartes; Paris France
| | - E. Thervet
- Department of Nephrology; Hôpital Européen Georges Pompidou; University René Descartes; Paris France
| | - N. Dupin
- Department of Dermatology; Hôpital Cochin; APHP; University René Descartes; Paris France
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