Abstract
Fast tacrolimus (Tac) metabolism is associated with reduced survival rates after renal transplantation (RTx), mainly due to cardiovascular events. Because dyslipidemia is a leading cause of cardiovascular death, we hypothesized that most RTx patients do not achieve recommended target low-density lipoprotein cholesterol (LDL-C) levels (European cardiology society guidelines) and that fast Tac metabolizers have higher dyslipidemia rates. This study included RTx recipients who received initial immunosuppression with immediate-release tacrolimus (IR-Tac), mycophenolate, and prednisolone. Patients were grouped according to their Tac concentration-to-dose ratio (C/D ratio) 3 months after RTx. Dyslipidemia parameters were analyzed at RTx, 3 months, and 12 months after RTx. Statin use and renal function were documented in a 12-month follow-up, and death was documented in a 60-month follow-up. Ninety-six RTx recipients were divided into two groups: 31 fast Tac metabolizers (C/D ratio < 1.05 ng/mL·1/mg) and 65 slow metabolizers (C/D ratio ≥ 1.05 ng/mL·1/mg). There were no differences in triglyceride or cholesterol levels between groups at RTx, 3, and 12 months after RTx. A total of 93.5% of fast and 95.4% of slow metabolizers did not achieve target LDL-C levels (p = 0.657). Fast metabolizers developed lower renal function compared to slow metabolizers 12 months after RTx (p = 0.009). Fast metabolizers showed a 60 month survival rate of 96.8% compared to 94.7% in the slow metabolizer group (p = 0.811). As most RTx recipients do not reach recommended target LDL-C levels, individualized nutritional counseling and lipid-lowering therapy must be intensified. Fast Tac metabolism is associated with lower renal function after RTx, but does not play a significant role in dyslipidemia.
Highlights
Renal transplantation (RTx) is the preferred renal replacement procedure compared to dialysis [1]
Most RTx recipients do not reach estimated glomerular filtration rates compared with healthy controls, which is important because the eGFR has an inverse relationship with cardiovascular disease [3,4]
REIN study collaborators showed that patients with chronic kidney disease (CKD) in should achieve a target low-density lipoprotein cholesterol (LDL-C) level of at least < 70 mg/mL
Summary
Renal transplantation (RTx) is the preferred renal replacement procedure compared to dialysis [1]. REIN study collaborators showed that patients with chronic kidney disease (CKD) in should achieve a target LDL-C level of at least < 70 mg/mL. The CKD-REIN study stages G3a–5 who are eligible for lipid-lowering therapy are frequently untreated, and collaborators showed that patients with chronic kidney disease (CKD) in stages G3a–5 who those who receive therapy rarely achieve LDL-C targets [6]. As described for CKD patients [3], CV events were the cipients do not achieve levels suggested by the ESCthat [9] It was main reason of death in recommended these cohorts. Tac metabolism is associated with an increased decline of renal funcRTx recipients do not achieve recommended LDL-C levels as suggested by the ESC [9]. We hypothesized that fast Tac metabolism is related to higher triglyceride and cholesterol levels, which may promote CV disease
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