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Effect of different immunosuppressive regimens on the evolution of distinct metabolic parameters: evidence from the Symphony study

Claes, Kathleen; Meier-Kriesche, Herwig-Ulf; Schold, Jesse D.; Vanrenterghem, Yves; Halloran, Philip F. and Ekberg, Henrik LU (2012) In Nephrology Dialysis Transplantation 27(2). p.850-857
Abstract
The metabolic syndrome (MS) is an important risk factor for graft dysfunction and patient death after renal transplantation. The aim of this sub-analysis of the Symphony study was to assess the progression of the laboratory parameters associated with MS in the first year after transplantation. Data collected from the Symphony study were used; 1645 patients were randomized to receive standard-dose cyclosporine (Stand-CsA), low-dose cyclosporine (Low-CsA), tacrolimus (Low-Tac) or sirolimus (Low-SRL), in addition to mycophenolate mofetil (MMF) and corticosteroids. Data were collected for levels and progression over the first year post-transplantation of systolic and diastolic blood pressure, uric acid, triglycerides, low-density lipoprotein... (More)
The metabolic syndrome (MS) is an important risk factor for graft dysfunction and patient death after renal transplantation. The aim of this sub-analysis of the Symphony study was to assess the progression of the laboratory parameters associated with MS in the first year after transplantation. Data collected from the Symphony study were used; 1645 patients were randomized to receive standard-dose cyclosporine (Stand-CsA), low-dose cyclosporine (Low-CsA), tacrolimus (Low-Tac) or sirolimus (Low-SRL), in addition to mycophenolate mofetil (MMF) and corticosteroids. Data were collected for levels and progression over the first year post-transplantation of systolic and diastolic blood pressure, uric acid, triglycerides, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and fasting glucose levels by treatment arm. The low-SRL group had significantly higher levels of triglycerides and LDL. The two CsA arms were associated with the highest uric acid levels at each time point. There were no significant differences in overall levels or changes in glucose or HDL. Patients in the standard-CsA arm had significantly higher diastolic blood pressure than those in the Low-SRL and Low-Tac arms. Systolic blood pressure was higher in the Low-CsA arm than in the Low-Tac arm. The use of antihypertensive and antidiabetic agents was similar between the treatment arms. In the Low-SRL arm, more patients were treated with lipid-lowering therapy. Mean daily steroid doses were the highest in the Low-SRL arm. This sub-analysis demonstrates that there is a difference in metabolic parameters between immunosuppressive groups. CsA therapy was associated with the highest values of uric acid and systolic and diastolic blood pressure. Patients on SRL therapy had the worst lipaemic control. A possible effect of Tac on new-onset diabetes could not be excluded. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
calcineurin inhibitor, metabolic parameters, renal transplantation, Symphony study
in
Nephrology Dialysis Transplantation
volume
27
issue
2
pages
850 - 857
publisher
Oxford University Press
external identifiers
  • wos:000300421300061
  • scopus:84856882247
ISSN
1460-2385
DOI
10.1093/ndt/gfr238
language
English
LU publication?
yes
id
e07466b2-75e0-4057-b34e-906d23d10b6a (old id 2409551)
date added to LUP
2012-04-02 09:29:51
date last changed
2017-09-10 04:07:23
@article{e07466b2-75e0-4057-b34e-906d23d10b6a,
  abstract     = {The metabolic syndrome (MS) is an important risk factor for graft dysfunction and patient death after renal transplantation. The aim of this sub-analysis of the Symphony study was to assess the progression of the laboratory parameters associated with MS in the first year after transplantation. Data collected from the Symphony study were used; 1645 patients were randomized to receive standard-dose cyclosporine (Stand-CsA), low-dose cyclosporine (Low-CsA), tacrolimus (Low-Tac) or sirolimus (Low-SRL), in addition to mycophenolate mofetil (MMF) and corticosteroids. Data were collected for levels and progression over the first year post-transplantation of systolic and diastolic blood pressure, uric acid, triglycerides, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and fasting glucose levels by treatment arm. The low-SRL group had significantly higher levels of triglycerides and LDL. The two CsA arms were associated with the highest uric acid levels at each time point. There were no significant differences in overall levels or changes in glucose or HDL. Patients in the standard-CsA arm had significantly higher diastolic blood pressure than those in the Low-SRL and Low-Tac arms. Systolic blood pressure was higher in the Low-CsA arm than in the Low-Tac arm. The use of antihypertensive and antidiabetic agents was similar between the treatment arms. In the Low-SRL arm, more patients were treated with lipid-lowering therapy. Mean daily steroid doses were the highest in the Low-SRL arm. This sub-analysis demonstrates that there is a difference in metabolic parameters between immunosuppressive groups. CsA therapy was associated with the highest values of uric acid and systolic and diastolic blood pressure. Patients on SRL therapy had the worst lipaemic control. A possible effect of Tac on new-onset diabetes could not be excluded.},
  author       = {Claes, Kathleen and Meier-Kriesche, Herwig-Ulf and Schold, Jesse D. and Vanrenterghem, Yves and Halloran, Philip F. and Ekberg, Henrik},
  issn         = {1460-2385},
  keyword      = {calcineurin inhibitor,metabolic parameters,renal transplantation,Symphony study},
  language     = {eng},
  number       = {2},
  pages        = {850--857},
  publisher    = {Oxford University Press},
  series       = {Nephrology Dialysis Transplantation},
  title        = {Effect of different immunosuppressive regimens on the evolution of distinct metabolic parameters: evidence from the Symphony study},
  url          = {http://dx.doi.org/10.1093/ndt/gfr238},
  volume       = {27},
  year         = {2012},
}