Abstract
Abstract Background and Aims High intrapatient variability (IPV) of tacrolimus trough levels is associated with poor long-term outcome after transplantation. Polypharmacy, related to the high co-morbidity, may affect the pharmacokinetics of tacrolimus in a substantial proportion of kidney transplant recipients (KTRs). We aimed to evaluate whether the number of regularly prescribed medications is associated with the tacrolimus IPV. Method We studied 152 tacrolimus-treated KTRs with mean post-transplant time 6.0±3.1 years, without dosing changes over the consecutive 2 years. The coefficient of variation (CV) as a measure IPV was calculated in each patient. Data concerning the type (generic name) and number of currently prescribed medications were collected. The participants were divided into 4 groups, based on the number of regularly prescribed drugs (≤3; 4-6; 7-9; ≥10). Results The median daily pill burden was 6.2±2.5 (ranged 2 to 15). There was an increasing trend for median CV, proportional to the increasing number of medications [group 1: 0.11 (IQR 0.08-0.14); group 2: 0.14 (0.01-0.17); group 3: 0.17 (0.14-0.23); group 4: 0.17 (0.15-0.30); p value for trend = 0.001]. Stepwise backward multivariate regression analysis revealed that the number of medications [partial correlation coefficient (rpartial) = 0.503; p<0.001], age [rpartial = -0.150; p=0.07] and eGFR [rpartial = -0.140; p=0.09] independently influenced the tacrolimus IPV (R2=0.30). Concomitant steroids or diuretics use increased IPV only in Advagraf-treated KTRs, whereas PPIs or statin use increased IPV in Prograf, but not Advagraf group. Conclusion: The number of medications is positively associated with tacrolimus IPV in stable KTRs. There were also tacrolimus formulation-dependent differences in the assumed influence of several concomitantly received classes of medications, including steroids, diuretics, PPIs and statins, on the tacrolimus IPV.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.