Incidence of Proteinuria after Initiation of Everolimus in Heart Transplantion. May It Have Repercussion on Renal Function?

Abstract

Purpose Proliferation signal inhibitors(PSI) used after heart transplantation(HT) may reduce post-HT complications. The proteinuria associated with using PSI leads to deterioration of renal function(RF). Purpose To determine the incidence of proteinuria after beginning of Everolimus(EVE) and his influence on RF. Methods and Materials Retrospective study of 54HT patients receiving EVE in late phase. 4patients were excluded due to basal pathological proteinuria. Immunosuppression was Cyclosporine (CyA) vs Tacrolimus (FK), MMF vs Azathioprine and prednisone. Proterinuria was determined using urine dipstick method and value Results 50HT patients were analyzed (92% men, mean age:61±11 years), mean time between HT-EVE initiation 6±5 years. The mean proteinurina and creatinine(pre-EVE) was 12’5 mg/dl(12- 7’6) and 1’56 mg/dl (0’8-3’30). 86% had statins and 48% ACEi or ARBs. After EVE starting the incidence of proteinuria at 1, 3, 6 and 12 months was: 5(10%), 9(18%), 10(20%), 14(28%) respectively, with a median of 11(1’5-29), 17’3(4-93), 14(3’9-98) and 18(5-132). Median of RF evolution analyzed according to proteinuria (absence/presence) at pre was 53’7/53’8 (21-103/29-160); and for months 1,3,6,12 was: 54’6/54’7 (25-105/28-154); 50’4/66’3 (20-107/25-154); 57/53 ( 23-109/25/100); 47’7/54’4 ( 28-94/29-118) respectively,p=NS. No significant differences were found in the development of proteinuria and taking ACEi or ARBs. Conclusions The incidence of proteinuria to the year of the EVE initiation in long-term HT patients is 28%. EVE utilization in patients without proteinuria before beginning appears safe and is not associated with a significant increase in proteinuria or renal impairment. However, the number is small so that further studies with larger series are needed to confirm this hypothesis.