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Rodrigo E, Barreda P, Cañamero L, Boya M, del Mar García Saiz M, Valero San Cecilio R, Belmar Vega L, Kislikova M, Angeles de Cos M, Carlos Ruiz San Millán J. MO1013: What is the Best Measure of Time in the Therapeutic Range of Tacrolimus for Kidney Transplantation? Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac088.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Tacrolimus is the main immunosuppressive drug in the vast majority of kidney transplants, but it is a drug with a narrow therapeutic margin. Each centre must establish therapeutic ranges to optimize its efficacy and minimize its toxic effects. Maintaining levels in the appropriate range is difficult due to its inherent inter- and intra-patient variability. In the monitoring of transplants, in addition to assessing the drug levels at each visit, the measurement of time in therapeutic range (TTR) allows us to measure how long the patient has been exposed to the appropriate doses. Currently, it is not known which are the optimal ranges of time or of blood levels that are better related to the subsequent evolution of kidney transplantation.
METHOD
We performed a single centre, observational study of 215 consecutive kidney transplant recipients performed in our centre from October/2014 to January/2020 who received uninterrupted treatment with tacrolimus during the first year, excluding hypersensitized recipients. TTR was calculated using the Rosendaal method between months 3 and 12 (TTR-M3-12) or 6 and 12 (TTR-M6-12) with a target for blood levels >6 ng/mL (TTR-M3-12-T > 6, TTR-M6-12-T > 6) or between 6 and 10 ng/mL (TTR-M3-12-T6-10, TTR-M6-12-T6-10).
RESULTS
The mean follow-up time was 4.1 ± 2.0 years. The TTR that had a greater capacity to discriminate the risk of rejection {TTR-M3-12-T > 6: AUC-ROC 0.614, [95% confidence interval (95% CI) 0.513–0.714]; P = .018; TTR-M6-12-T > 6: AUC-ROC 0.607, 95% CI 0.502–0.713, P = .029; TTR-M3-12-T6-10: AUC-ROC 0.610, 95% CI 0.516–0.703, P = .023; TTR-M6-12-T6-10; AUC-ROC 0.596, 95% CI 0.495–0.696, P = .051} during the first year and of having a glomerular filtration rate of <30 mL/min/1.73 m2 at the first year (TTR-M3-12-T > 6: AUC-ROC 0.676, 95% CI 0.542–0.811; P = .014; TTR-M6-12-T > 6: AUC-ROC 0.623, 95% CI 0.511–0.795; P = .037; TTR-M3-12-T6-10: AUC-ROC 0.566, 95% CI 0.429–0.703; P = .358; TTR-M6-12-T6-10: AUC-ROC 0.575, 95% CI 0.446–0.703; P = .310) was TTR-M3-12-T > 6. By Cox regression, the TTR that was significantly related to death censored graft loss of the kidney graft censoring for death was TTR-M3-12-T > 6 (TTR-M3-12-T > 6: HR = 0.972, 95% CI 0.949–0.995; P = .079; TTR-M6-12-T > 6: HR = 0.980, 95% CI 0.961–0.998; P = .033; TTR-M3-12-T6-10: HR = 0.985, 95% CI 0.962–1.009; P = .230; TTR-M6-12-T6-10: HR = 0.987, 95% CI 0.968–1.007; P = .199). By multivariate Cox regression analysis, patients in the lower tertile of TTR (HR = 10.027, 95% CI 1.244–81.447; P = .031) had worse survival than those in the upper tertiles, regardless of kidney function in the first year (Fig. 1).
CONCLUSION
The measurement of TTR after kidney transplantation makes possible to easily estimate the time of exposure to adequate levels of tacrolimus, relating it to the risk of acute rejection, kidney function in the first year, and death-censored graft survival. Among the possible TTR measures, the one that is best related to post-transplant outcome is taking into account tacrolimus blood levels between month 3 and 12 and those >6 ng/mL (TTR-M3-12-T > 6).
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Affiliation(s)
- Emilio Rodrigo
- Nephrology, University Hospital Marqués de Valdecilla/IDIVAL, Santander, Spain
| | - Paloma Barreda
- Nephrology, University Hospital Marqués de Valdecilla/IDIVAL, Santander, Spain
| | - Lucía Cañamero
- Nephrology, University Hospital Marqués de Valdecilla/IDIVAL, Santander, Spain
| | - Marta Boya
- Nephrology, University Hospital Marqués de Valdecilla/IDIVAL, Santander, Spain
| | | | | | - Lara Belmar Vega
- Nephrology, University Hospital Marqués de Valdecilla/IDIVAL, Santander, Spain
| | - María Kislikova
- Nephrology, University Hospital Marqués de Valdecilla/IDIVAL, Santander, Spain
| | - María Angeles de Cos
- Clinical Pharmacology, University Hospital Marqués de Valdecilla/IDIVAL, Santander, Spain
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Quiroga B, Soler MJ, Ortiz A, Bernat A, Díaz ABM, Mantecón CJJ, Pérez VOG, González CC, Cervienka M, Mazuecos A, Cazorla JM, Riso MCD, Martínez S, Diaz MO, Valverde RL, Márquez MGS, Novillo CL, Parra EG, Gracia-Iguacel C, De Tomas MTR, Cervera MCA, Giorgi M, Ramos PM, Carmona NM, Toapanta N, Guldris SC, Millán JCRS, Estupiñán RS, Crespo M, Linaza BV, Martín MIJ, Jiménez LRO, Soriano S, Ferri DG, Sánchez MSP, Yugueros A, Leyva A, Rojas J, Gansevoort RT, de Sequera P, Carretero MP, Tocora DG, Rodríguez MJ, Zanón TT, Suárez ER, Santolaya AJS, Calero RC, Cobo PA, Martin-Cleary C, Sánchez-Rodríguez J, Pereira M, Ramos-Verde A, Sánchez C, Giraldo YG, Horrillo AS, Suárez PR, Perpén AF, Ramos AF, Villanueva LS, Cortiñas A, Arias PAD, Cárdenas AC, de Santos A, Núñez A, Cuadrado GB, Repollet R, Moreso F, Azancot MA, Ramos N, Bestard O, Cidraque I, Bermejo S, Agraz I, Prat O, Medina C, Pardo E, Saiz A, Vila MAM, Granados NM, Cabo MJC, Alarcón WL, Alexandru S, Suarez LGP, Saico SP, Tapia MP, Hernández RS, García-Fernández N, Moreno PLM, González NA, Ortiz AS, Iñarrea MNB, López RO, Peregrí CM, Morales MLA, Cabello MDN, Ribera AMT, Valcarce EG, Vergara EG, García T, Narváez C, Orellana C, Ganga PLQ, Carrión FV, Herrera ALG, Chamoun B, Barbosa F, Faura A, Pachón DR, Castro NB, Cendrero RMRC, Hidalgo-Barquero MVM, Gallego RH, Alvarez Á, Leo EV, León JLP, García MAM, Jiménez BG, Moya JDDR, Espinosa DL, Herrador AJ, Zurita MN, Álvarez LD, Martínez ÁG, Arroyo SB, Fernández RR, Vargas MJS, Casero RC, Useche G, de Miguel CS, Palacios Á, Henningsmeyer B, Calve EO, Moya JL, Sato Y, Marín MS, Torres I, Conde PD, Alfaro G, Halauko O, Rifai FEL, Martínez AD, Ávila PJ, Franco AM, Sainz MS, Martín JMB, García LDR, Canga JLP, Ochoa PMV, Pacios LM, Machado LL, Morales AQ, Cavalotti IM, Zorita IN, López SO, González SO, Montañez CS, Rubio AB, Gilsanz GDP, Gonzalez MO, Villanueva RS, Oliva MOL, Varela JC, Enríquez AG, Casas CC, Alonso PO, Tabares LG, Barreiro JML, Solla LP, Gándara A, de la Garza WN, Fleming FF, Goyanes MGR, Feijoo CC, Plaza MMM, Juan CB, Cecilio RVS, Haces CP, Kislikova M, Rodrigo E, Contreras FJP, Lara NB, Llorente EMDB, Díaz LS, Bustamante AMC, Ruiz JM, Rodríguez EG, Perez VLDLM, Arevalo MC, Calvo JAH, Carratalá MRL, Rodríguez LMM, Salazar MS, Prieto BB, Pérez JMP, Rueda DA, Ferrero MLR, Martínez AV, Estébanez SA, Paraíso AG, Huarte E, Lanau M, Campos RA, Ubé JM, Pérez PS, Godoy IB, Aguilera ET, Alea RT, Saldaña MSDR, Salvetti ML, Valmajor MC, Sánchez MP, Barragán ML, Aunatell LR, Salgueira M, Aresté N, de Los Ángeles Rodríguez M, Collantes R, Martínez AI, Moyano MJ, Víbora EJ, Gash SC, Martínez LR, Prieto BA, Toyos C, Rio JM, Acosta AR, Zamacona AC, Ortega SB, Ruiz MIG, Rubio AH, Ledesma PG, Alvarez AG, de Briñas EPL, Cucchiari D, Monzo JB, Cabrera BE, Hernández APR, Rebollo MSG, Hernández JMR, Alonso JC, Más AM, Calvé M, Cardona MG, Balaguer VC, Pesquera JIM, Serrano AG, Simó PT, Mancilla HDR, Gómez MP, Gumpert JV, de la Fuente GDA, Del Valle KP, de la Rosa EC, Santarelli DR, Garcia AS, Martin-Caro AC, Santamaria IM, Umpierrez AM, Ruiz EH, Corbella AM, Perdomo KT, Martín YM, de la Pisa AMU, Monzon LS, Anachuri KA, Garcia EH, Gomez VO, Amado FV, Borges PP, Vázquez RM, Beloso MD, Alonso FA, Felpete NP, Ameneiro AM, Mera MC, Casares BG, Larrondo SZ, Kareaga NM, Del Valle AISS, García ARM, Del Toro Espinosa N, Perico PE, Oliva JMS, Manrique J, Castaño I, Purroi C, Gómez N, Mansilla C, Utzurrum A. Loss of humoral response 3 months after SARS-CoV-2 vaccination in the CKD spectrum: the multicentric SENCOVAC study. Nephrol Dial Transplant 2022; 37:994-999. [PMID: 35022757 PMCID: PMC9383183 DOI: 10.1093/ndt/gfac007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Borja Quiroga
- Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain.,RICORS2040 (Kidney Disease)
| | - Alberto Ortiz
- RICORS2040 (Kidney Disease).,IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Mayra Ortega Diaz
- Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
| | - Rafael Lucena Valverde
- Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
| | | | | | - Emilio González Parra
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Carolina Gracia-Iguacel
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | | | - Martín Giorgi
- Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Néstor Toapanta
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | | | - Raquel Santana Estupiñán
- Nephrology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | | | | | | | | | - Alejandra Yugueros
- Nephrology Department, Hospital Lluis Alcanyis De Xátiva, Valencia, Spain
| | - Alba Leyva
- R&D Department, VIRCELL SL, Granada, Spain
| | - José Rojas
- R&D Department, VIRCELL SL, Granada, Spain
| | - Ron T Gansevoort
- Dept. Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Patricia de Sequera
- RICORS2040 (Kidney Disease).,Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
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Belmar Vega L, de Francisco A, Albines Fiestas Z, Serrano Soto M, Kislikova M, Seras Mozas M, Unzueta MG, Arias Rodríguez M. Investigation of iron deficiency in patients with congestive heart failure: A medical practice that requires greater attention. Nefrologia 2016; 36:249-54. [PMID: 27056405 DOI: 10.1016/j.nefro.2016.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/29/2015] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Iron deficiency in congestive heart failure (CHF), with or without concomitant anaemia, is associated with health-related quality of life, NYHA functional class, and exercise capacity. Prospective, randomised studies have demonstrated that correcting iron deficiency improves the quality of life and functional status of patients with CHF, including those who do not have anaemia. OBJECTIVE The aim of this study was to analyse how frequently these iron parameters are tested and thus determine the extent to which this quality improvement tool has been implemented in patients admitted with CHF. METHODS Retrospective observational study of patients from a university hospital diagnosed with CHF on admission between 01/01/2012 and 11/06/2013. RESULTS Iron parameters were tested in 39% (324) of the 824 patients analysed. There was no significant difference in age between the patients whose iron was tested and those whose iron was not tested, but the difference in terms of gender was significant (P=.007). Glomerular filtration rate and haemoglobin, were significantly lower in the group of patients whose iron was tested (P<.001). The proportion of patients with anaemia, renal failure or both was significantly higher in the group of patients who had iron tests (P<.001). Of the 324 patients whose iron parameters were tested, 164 (51%) had iron deficiency. There were no differences between patients with and without iron deficiency in terms of age or gender. The iron parameters in both groups, ferritin and transferrin saturation index were significantly lower among the patients with iron deficiency (P<.001). The glomerular filtration rate values were significantly lower in patients with no iron deficiency (P<.001). Significant differences were also observed between those with and without iron deficiency in the proportion of patients with renal failure (79 vs. 66%, respectively, P=.013), but not in terms of haemoglobin concentration. CONCLUSION Congestive heart failure is very frequently associated with anaemia, iron deficiency and renal failure. Despite the fact that correcting iron deficiency is known to improve symptoms, testing of iron parameters in patients admitted with CHF is not performed as often as it should be.
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Affiliation(s)
- Lara Belmar Vega
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
| | - Alm de Francisco
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España
| | - Zoila Albines Fiestas
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España
| | - Mara Serrano Soto
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España
| | - María Kislikova
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España
| | - Miguel Seras Mozas
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España
| | - Mayte García Unzueta
- Departamento de Análisis Clínicos, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España
| | - Manuel Arias Rodríguez
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España
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Kislikova M, Seras M, Monfa E, Rodrigo E, Fernandez-Fresnedo G, Ruiz JC, Arias M. Number of antihypertensive drugs at 1 year after kidney transplantation. Transplant Proc 2015; 47:76-7. [PMID: 25645775 DOI: 10.1016/j.transproceed.2014.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
High blood pressure (BP) affects up to 90% of kidney transplant recipients and is associated with lower patient and graft survival rates. Kidney Disease/Improving Global Outcomes (KDIGO) guidelines suggest maintaining BP at lower than 130/80 mm Hg. Multidrug therapy is usually required for the control of BP in this population. Our aim was to analyze the number of antihypertensive drugs used in our kidney transplantation population at 1 year after transplantation and their influence on graft and patient outcome. We included 411 deceased-donor kidney transplantation cases; data were obtained from a prospectively maintained institutional database. BP was measured at the outpatient clinic. Approximately 97 patients were not under antihypertensive therapy, whereas 130, 119, 52, and 13 received 1, 2, 3, or 4 antihypertensive drugs, respectively. The number of antihypertensive drugs was significantly related to lower patient survival rates independently of a previous diagnosis of hypertension and diabetes, recipient age and sex and renal function at 1-year. After multivariate linear regression analysis high body mass index, male gender of recipients, donor hypertension, previous acute rejection, and cyclosporine therapy were risk factors independently related to a higher number of antihypertensive drugs. To conclude, the number of antihypertensive drugs is an objective and easy-to-measure marker related to lower patient survival rates. Recipient body mass index, type of calcineurin inhibitor, and acute rejection are modifiable risk factors whose control can help to reduce the number of antihypertensive drugs needed to treat high BP in the kidney transplantation population.
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Affiliation(s)
- M Kislikova
- Hospital Universitario Marques de Valdecilla, Santander, Spain.
| | - M Seras
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - E Monfa
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - E Rodrigo
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | - J C Ruiz
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - M Arias
- Hospital Universitario Marques de Valdecilla, Santander, Spain
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